To quantitatively compare nickel and chromium ion release and corrosion resistance of copper–nickel–titanium (Cu–NiTi), stainless steel (SS), and beta-titanium (β-Ti) archwires following immersion in povidone-iodine (Betadine), chlorhexidine, amine fluoride (Amflor) mouthwashes, and distilled water. An in vitro study was performed using 60 rectangular archwire specimens (20 each of Cu–NiTi, SS, and β‑Ti), divided into four subgroups according to the immersion medium (chlorhexidine, Betadine, Amflor, distilled water; n = 5 per subgroup). Wires were immersed in each solution at 37 °C for 1.5 h to simulate approximately 3 months of daily mouthwash exposure. Metal ion release was analyzed by atomic absorption spectrophotometer (AAS), while corrosion behavior was assessed using potentiodynamic polarization via a Zive SP1 potentiostat. Two-way analysis of variance (ANOVA) with Tukey’s post hoc test was used to determine statistically significant effects of wire and solution type (p < 0.05). Significant differences were observed among wire and solution types (p < 0.001). β‑Ti wires showed no detectable metal ion release and the lowest corrosion rates. Cu–NiTi and SS wires exhibited measurable nickel release, highest in chlorhexidine (46.91 ppm for Cu–NiTi, 42.93 ppm for SS). Chromium release was exclusive to SS (maximum 23.62 ppm). The corrosion hierarchy was chlorhexidine > Betadine > Amflor > distilled water, with β‑Ti demonstrating superior resistance. Both material composition and mouthwash formulation critically affect corrosion and ion release. β‑Ti exhibits optimal biocompatibility, whereas chlorhexidine significantly accelerates corrosion.
This study compared visualization methods for removing excess composite around ellipsoid and rectangular attachments used in clear aligner therapy (CAT). Ninety teeth were divided into three groups based on how they were assessed during cleaning: direct vision (group I), ultraviolet (UV) light (group II), and dental loupe (group III). Each group had two subgroups: rectangular (group A) and ellipsoid (group B) attachments. Excess composite was removed using tungsten carbide burs, and the clean-up duration was recorded. Surface deviations were evaluated by scan superimposition, and surface morphology was examined using scanning electron microscopy. Data were analyzed using parametric or nonparametric tests (p < 0.05). Group IA showed significantly longer clean-up duration than groups IIA and IIIA (p < 0.001). Group IB also differed significantly from group IIB (p = 0.012). Group IIB demonstrated significantly lower residual composite values than the other groups. Auxiliary visualization methods, particularly UV light, improved excess composite clean-up around orthodontic attachments and reduced chairside time. This may help clinicians optimize attachment bonding and enhance aligner fit.
Evidence comparing the dentofacial effects of lingual and labial fixed appliances in adults treated with four-premolar extractions is limited, particularly when skeletal anchorage is considered. This study compared posttreatment incisor inclination, vertical pattern, and lip position between the two appliance types by analyzing lateral cephalograms. This retrospective comparative study included 118 adults treated in one private practice (59 with lingual, 59 with labial fixed appliances). Primary outcomes were posttreatment maxillary incisor to sella-nasion angle (U1-SN) and mandibular incisor to mandibular plane angle (IMPA). Secondary outcomes were sella-nasion to gonion-gnathion angle (SN-GoGn), upper lip to esthetic line distance (UL-E), and lower lip to esthetic line distance (LL-E). Outcomes were compared using analysis of covariance adjusted for the pretreatment value, Angle classification, crowding, and the number of temporary anchorage devices (TADs). Sensitivity models additionally adjusted for age, sex, and treatment duration. Adjusted posttreatment U1-SN was lower in the lingual group than in the labial group (adjusted difference, −4.40°; 95
To compare the acceleration effect of piezocision and modified piezocision (a combination of piezocision and piezopuncture) on canine retraction. In this two-arm parallel, split-mouth randomized clinical trial, 30 participants (15–25 years) undergoing fixed orthodontic treatment with the extraction of first upper premolars and canine retraction were randomly assigned to piezocision or modified piezocision groups. Thirty surgical procedures were performed using a split-mouth design, with 15 in each interventional arm, and the contralateral sides were treated in a conventional way (control). Outcomes assessed included the amount of canine retraction (primary outcome variable), rotation, inclination changes, root resorption, and molar anchorage loss. Data analysis included paired t‑tests, Wilcoxon signed-rank tests (between experimental and control sides), independent t‑tests, and Mann–Whitney U tests (between experimental sides). The level of significance was set at P < 0.05. Canine retraction on the experimental side in the piezocision group was 1.5 times greater than on the control side (3.83 ± 0.17 mm vs. 2.46 ± 0.31 mm, P < 0.001). In the modified piezocision group, retraction was nearly twice as great on the experimental side compared to the control (5.13 ± 0.14 mm vs. 2.50 ± 0.32 mm, p = 0.001). The modified piezocision technique showed significantly higher (p-value < 0.001) canine retraction than the original piezocision technique. Secondary outcomes showed nonsignificant differences. No harm was observed other than mild postsurgical pain and swelling, which were controlled with appropriate medications. Both modified and traditional piezocision techniques effectively accelerated canine retraction. However, the modified technique demonstrated superior results, offering a promising avenue for future orthodontic practice.
Artificial intelligence (AI) is rapidly transforming orthodontics, yet a comprehensive and up-to-date bibliometric analysis is lacking. This study systematically maps key research areas, influential contributors, and collaborative networks driving AI innovation. A comprehensive search was conducted in the Web of Science (Clarivate, London, UK) for AI and orthodontics articles up to January 10, 2026. CiteSpace (version 6.2.R6, Drexel University, Philadelphia, PA, USA) and VOSviewer (version 1.6.20, Centre for Science and Technology Studies, Leiden University, Leiden, The Netherlands) were used to extract and visualize the data, including publications, journals, institutions, countries, highly cited articles, authors, and keywords. A total of 454 articles were included, authored by 2150 authors affiliated with 674 institutions across 64 countries. The research landscape has expanded exponentially since 2019, with the USA, China, and South Korea emerging as primary global collaboration hubs. Keyword burst analysis highlighted the rapid clinical integration of AI applications in image recognition, diagnosis, and evaluation. This study maps AI integration trends, showing how AI enhances diagnostic precision and treatment evaluation. These insights might be able to guide researchers toward cutting-edge frontiers. Future research should prioritize multimodal data integration, personalized treatment workflows, and patient privacy protection.
PURPOSE:Artificial intelligence (AI) is rapidly transforming orthodontics, yet a comprehensive and up-to-date bibliometric analysis is lacking. This study systematically maps key research areas, influential contributors, and collaborative networks driving AI innovation. METHODS:A comprehensive search was conducted in the Web of Science (Clarivate, London, UK) for AI and orthodontics articles up to January 10, 2026. CiteSpace (version 6.2.R6, Drexel University, Philadelphia, PA, USA) and VOSviewer (version 1.6.20, Centre for Science and Technology Studies, Leiden University, Leiden, The Netherlands) were used to extract and visualize the data, including publications, journals, institutions, countries, highly cited articles, authors, and keywords. RESULTS:A total of 454 articles were included, authored by 2150 authors affiliated with 674 institutions across 64 countries. The research landscape has expanded exponentially since 2019, with the USA, China, and South Korea emerging as primary global collaboration hubs. Keyword burst analysis highlighted the rapid clinical integration of AI applications in image recognition, diagnosis, and evaluation. CONCLUSION:This study maps AI integration trends, showing how AI enhances diagnostic precision and treatment evaluation. These insights might be able to guide researchers toward cutting-edge frontiers. Future research should prioritize multimodal data integration, personalized treatment workflows, and patient privacy protection.
PURPOSE:To compare the acceleration effect of piezocision and modified piezocision (a combination of piezocision and piezopuncture) on canine retraction. METHODS:In this two-arm parallel, split-mouth randomized clinical trial, 30 participants (15-25 years) undergoing fixed orthodontic treatment with the extraction of first upper premolars and canine retraction were randomly assigned to piezocision or modified piezocision groups. Thirty surgical procedures were performed using a split-mouth design, with 15 in each interventional arm, and the contralateral sides were treated in a conventional way (control). Outcomes assessed included the amount of canine retraction (primary outcome variable), rotation, inclination changes, root resorption, and molar anchorage loss. Data analysis included paired t‑tests, Wilcoxon signed-rank tests (between experimental and control sides), independent t‑tests, and Mann-Whitney U tests (between experimental sides). The level of significance was set at P < 0.05. RESULTS:Canine retraction on the experimental side in the piezocision group was 1.5 times greater than on the control side (3.83 ± 0.17 mm vs. 2.46 ± 0.31 mm, P < 0.001). In the modified piezocision group, retraction was nearly twice as great on the experimental side compared to the control (5.13 ± 0.14 mm vs. 2.50 ± 0.32 mm, p = 0.001). The modified piezocision technique showed significantly higher (p-value < 0.001) canine retraction than the original piezocision technique. Secondary outcomes showed nonsignificant differences. No harm was observed other than mild postsurgical pain and swelling, which were controlled with appropriate medications. CONCLUSION:Both modified and traditional piezocision techniques effectively accelerated canine retraction. However, the modified technique demonstrated superior results, offering a promising avenue for future orthodontic practice.
To investigate how age-related changes in midpalatal suture morphology influence skeletal response to varying force magnitudes in nonsurgical rapid palatal expansion (RPE) using a rat model. Nine rats were allocated to an age-based analysis (2, 4, and 8 months; n = 3 per group) to evaluate physiologic age-related development in midpalatal suture morphology. Thirty-five mature rats (8 months) were further assigned to light force (50 g), heavy force (200 g), or control groups. Forces were applied via custom-fabricated expansion devices for 3, 7, and 14 days. Micro-computed tomography (micro-CT), histological analysis, and immunohistochemistry were performed. Histological analysis included qualitative and quantitative assessments. Micro-CT was used for evaluating suture separation, bone volume fraction (BV/TV), and bone mineral density (BMD). Immunohistochemistry assessed the expression of bone remodeling markers. Increased age correlated with reduced midpalatal suture separation and bone formation. Heavy forces resulted in significantly greater suture separation at early time points but also induced more bone resorption, as indicated by lower BV/TV and BMD values. Immunohistochemistry confirmed increased RANKL expression in heavy force groups, indicating enhanced bone remodeling activity. Midpalatal suture response is significantly influenced by both age and the magnitude of applied force. While heavy force promotes faster suture separation, it leads to increased bone resorption and reduced bone quality. In contrast, light force results in a more gradual separation but supports earlier osteoclastic activity, greater vascularization, and better preservation of bone structure. These findings underscore the importance of age-appropriate force selection in nonsurgical RPE protocols.
OBJECTIVES:Successful orthognathic therapies are characterised by a physiologically configured occlusion whose long-term clinical stability is mainly assessed through occlusal parameters. In the present study, long-term treatment outcomes were assessed based on occlusal changes after 5 years using digital occlusion and masticatory efficiency analysis. METHODS:This study examined 33 adult patients after treatment of skeletal class II (n = 18; 12 women, median age 28.15 years; interquartile range [IQR] = 15.10) and class III malformations (n = 15; 7 women, median age 23.90 years; IQR = 4.80) 9 months (T1) and 5 years (T2) postorthognathic therapy. A total of 20 patients with neutral skeletal relation (10 women; median age 30.50 years; IQR = 7.50) served as a control group. Skeletal classification was based on sagittal jaw configuration (Wits) and habitual intercuspation was recorded using the T‑Scan Novus® (Tekscan Inc., South Boston, MA, USA) for digital occlusion analysis with the following variables: total tooth contact (TTC), occlusion time (TOC), occlusion asymmetry (OAS), anterior and posterior antagonism (ATC and PTC). In addition, masticatory performance was assessed using a standardized two-colour chewing gum bolus analysis. RESULTS:Five years after surgery (T2), none of the occlusal parameters differed significantly between the groups, indicating functional approximation to the control group. Longitudinal analysis revealed significant improvements within both surgical groups (T1 to T2). In class II patients, TTC, ATC and PTC increased, while TOC decreased significantly. Class III patients also showed significant increases in TTC, ATC and PTC with TOC and OAS remaining unchanged. Overall, both treatment groups demonstrated substantial recovery and long-term stabilization of occlusal function. Bolus homogeneity analysis showed no significant difference between control and treatment patients 5 years after surgery. CONCLUSION:The 5‑year observation of orthognathic treatment for sagittal jaw malformations showed significant improvements in occlusal parameters. Both masticatory efficiency and occlusal parameters measured at 5 years postoperatively did not differ significantly from the control group, indicating that the functional improvements achieved by the therapy were stable in the long term.
To examine associations between vertical craniofacial growth pattern, self-reported daytime sleepiness, sleep-related complaints, and lip posture in adolescents. This cross-sectional study included 157 adolescents aged 12–14 years classified as hyperdivergent (n = 121) or normodivergent (n = 36). Daytime sleepiness and sleep-related complaints were assessed using an Epworth sleepiness scale (ESS)-based questionnaire and Berlin questionnaire (BQ)-derived items. Lip posture was measured cephalometrically. Independent t‑tests, chi-square/Fisher exact tests, Pearson correlations, and multiple linear regression were used. Hyperdivergent adolescents had higher ESS and BQ scores (p < 0.001; ESS d = 0.70), more frequent sleep-disordered breathing (SDB)-related symptoms (p < 0.05), and a significant Frankfort mandibular plane angle (FMA)–ESS association after adjustment for age, body mass index, and sex (β =0.354, p < 0.001). Lip posture showed no group differences or associations with BQ, with only weak correlations with ESS or sleep duration. Hyperdivergence, but not lip posture, was associated with greater questionnaire-derived sleepiness and SDB symptoms.
Successful orthognathic therapies are characterised by a physiologically configured occlusion whose long-term clinical stability is mainly assessed through occlusal parameters. In the present study, long-term treatment outcomes were assessed based on occlusal changes after 5 years using digital occlusion and masticatory efficiency analysis. This study examined 33 adult patients after treatment of skeletal class II (n = 18; 12 women, median age 28.15 years; interquartile range [IQR] = 15.10) and class III malformations (n = 15; 7 women, median age 23.90 years; IQR = 4.80) 9 months (T1) and 5 years (T2) postorthognathic therapy. A total of 20 patients with neutral skeletal relation (10 women; median age 30.50 years; IQR = 7.50) served as a control group. Skeletal classification was based on sagittal jaw configuration (Wits) and habitual intercuspation was recorded using the T‑Scan Novus® (Tekscan Inc., South Boston, MA, USA) for digital occlusion analysis with the following variables: total tooth contact (TTC), occlusion time (TOC), occlusion asymmetry (OAS), anterior and posterior antagonism (ATC and PTC). In addition, masticatory performance was assessed using a standardized two-colour chewing gum bolus analysis. Five years after surgery (T2), none of the occlusal parameters differed significantly between the groups, indicating functional approximation to the control group. Longitudinal analysis revealed significant improvements within both surgical groups (T1 to T2). In class II patients, TTC, ATC and PTC increased, while TOC decreased significantly. Class III patients also showed significant increases in TTC, ATC and PTC with TOC and OAS remaining unchanged. Overall, both treatment groups demonstrated substantial recovery and long-term stabilization of occlusal function. Bolus homogeneity analysis showed no significant difference between control and treatment patients 5 years after surgery. The 5‑year observation of orthognathic treatment for sagittal jaw malformations showed significant improvements in occlusal parameters. Both masticatory efficiency and occlusal parameters measured at 5 years postoperatively did not differ significantly from the control group, indicating that the functional improvements achieved by the therapy were stable in the long term.
To evaluate the association between tooth agenesis and root morphology alterations. This retrospective observational study initially analyzed 27,707 medical records of patients from radiological centers in southeastern Brazil. After applying the inclusion and exclusion criteria, 1193 sets of periapical radiographs of maxillary incisors were selected from eligible patients aged between 8 and 30 years. The root morphology of the upper incisors was classified into five categories: normal, short, blunt, apically bent, or pipette-shaped, based on criteria established in the literature. In addition, missing teeth were recorded applying the tooth agenesis code (TAC). Two previously calibrated specialists analyzed the radiographs visually. Logistic regression with odds ratios (OR) estimated the associations between tooth agenesis and root alterations at a 5% significance level. Patients with any form of tooth agenesis were more likely to have pipette-shaped (i.e., roots with a narrow cervical third and gradual tapering toward the apex; OR = 7.04; 95% confidence interval [CI] 4.23–11.72) or blunt (OR = 5.31; 95% CI 2.62–10.75) roots. Conversely, the agenesis group showed a significantly lower prevalence of normal roots than the group without agenesis (OR = 0.12; 95% CI 0.07–0.20). Root morphology alterations are strongly associated with tooth agenesis. This knowledge should be used for customized approaches and multidisciplinary strategies to minimize complications and improve treatment in this group.
Surgically facilitated anterior maxillary distraction (AMD) is used for the treatment of maxillary hypoplasia secondary to cleft lip and palate (CLP). In this study, the soft and hard tissue changes following AMD in growing patients with CLP were evaluated to determine the extent of changes that occurred. Cephalometric records of 8 growing patients with maxillary hypoplasia secondary to CLP were obtained. They were treated with AMD using a modified hyrax appliance. The preoperative (T1) and postoperative records (T2: after 1 year of consolidation and growing period) were analyzed using Dolphin software (version 11.95; Dolphin Imaging, Chatsworth, CA USA) and subjected to statistical analyses. Cephalometric analysis was performed by the same operator. The values of SNA, U1-NA, U1-PP, U1-SN, L1-NB, AO-BO, OCC-SN angle, Sn-St increased significantly after the AMD procedure (p < 0.05). However, the soft tissue parameters nasolabial angle (Cm-Sn-Ls), facial height ([Gla]–Sn), and mentolabial sulcus depth (LiPo-Sm) did not show statistically significant changes (p < 0.05). These results concur that AMD produced midfacial profile changes in patients with CLP. After AMD, the negative overjet decreased and proclination of the upper incisors was observed. Soft tissue parameters did not show statistically significant changes during the study period. The study proved that changes to correct the class III malocclusion occur primarily in the hard tissue and the results were significant.
INTRODUCTION:Surgically facilitated anterior maxillary distraction (AMD) is used for the treatment of maxillary hypoplasia secondary to cleft lip and palate (CLP). In this study, the soft and hard tissue changes following AMD in growing patients with CLP were evaluated to determine the extent of changes that occurred. METHODS:Cephalometric records of 8 growing patients with maxillary hypoplasia secondary to CLP were obtained. They were treated with AMD using a modified hyrax appliance. The preoperative (T1) and postoperative records (T2: after 1 year of consolidation and growing period) were analyzed using Dolphin software (version 11.95; Dolphin Imaging, Chatsworth, CA USA) and subjected to statistical analyses. Cephalometric analysis was performed by the same operator. RESULTS:The values of SNA, U1-NA, U1-PP, U1-SN, L1-NB, AO-BO, OCC-SN angle, Sn-St increased significantly after the AMD procedure (p < 0.05). However, the soft tissue parameters nasolabial angle (Cm-Sn-Ls), facial height ([Gla]-Sn), and mentolabial sulcus depth (LiPo-Sm) did not show statistically significant changes (p < 0.05). CONCLUSION:These results concur that AMD produced midfacial profile changes in patients with CLP. After AMD, the negative overjet decreased and proclination of the upper incisors was observed. Soft tissue parameters did not show statistically significant changes during the study period. The study proved that changes to correct the class III malocclusion occur primarily in the hard tissue and the results were significant.
This prospective randomized clinical study aimed to evaluate the effectiveness of maxillary protraction with differently located miniplates combined with intermaxillary elastic applications after corticotomy in patients with skeletal class III malocclusion. Twenty patients aged 13–15 years were randomly assigned to one of three groups using a computer-generated random sequence. In the AS and MS groups, an acrylic splint (AS) with hooks in the upper molar region was cemented; the MS group additionally received two palatal miniscrews (MS) for anchorage. In all patients, incomplete Le Fort I osteotomy was performed. Miniplates were placed vertically between the mandibular canine and first premolar in all groups, and horizontally under the osteotomy line in the MP group. Class III elastics were applied 5 days postsurgery and continued until a positive overjet was achieved. Cephalometric radiographs were taken at the beginning of treatment (T0) and at the end of the protraction period (T1). The MP group exhibited the greatest maxillary advancement (3.2 ± 2.2 mm, p < 0.05). Significant B‑point changes occurred in the MP (−1.2 ± 1 mm, p < 0.05) and AS (−0.9 ± 0.9 mm, p < 0.05) groups. The AS group had the largest increase in upper incisor angulation (U1-SN: 5.5° ± 2.5; U1-PP: 4.7° ± 3.3, p < 0.05). All groups showed favorable soft tissue changes; in the MS group the best control of mandibular clockwise rotation was achieved. The duration of protraction period was 5.52 ± 0.9 months for the MP group, 4.84 ± 1.3 months for the AS group, and 4.74 ± 1.18 months for the MS group. Although significant improvement was observed in maxillomandibular relations in all groups, the greatest change was observed in the MP group (p < 0.01). The use of skeletal anchorage helped reduce dentoalveolar changes. The MS group was most successful in controlling clockwise rotation of the mandible.
To compare the incidence, severity, and regional distribution of white spot lesions (WSLs) between clear aligner therapy (CAT) and fixed appliance therapy (FAT) using standardized intraoral photographs supported by digital scans. This retrospective comparative study included pre- (T0) and posttreatment (T1) records of 100 patients treated with CAT or FAT. Enamel demineralization was assessed using the Enamel Decalcification Index (EDI; 0–3). All evaluations were performed by two calibrated, blinded examiners. Statistical analyses were conducted using SPSS (p < 0.05; version 21.0, IBM, Armonk, NY, USA). Posttreatment WSL counts were significantly lower in the maxillary and mandibular anterior regions in the CAT group, with no significant differences in the posterior regions. Although WSLs increased in both groups, the increase was lower after CAT. Total WSL counts were also significantly lower after CAT. In the FAT group, lesion development was more pronounced in the mandibular anterior region. CAT was associated with lower WSL burden and fewer newly developed lesions than FAT, particularly in the anterior regions. However, given the observational design, findings should be interpreted as associations rather than causal effects.
OBJECTIVE:To compare the incidence, severity, and regional distribution of white spot lesions (WSLs) between clear aligner therapy (CAT) and fixed appliance therapy (FAT) using standardized intraoral photographs supported by digital scans. MATERIALS AND METHODS:This retrospective comparative study included pre- (T0) and posttreatment (T1) records of 100 patients treated with CAT or FAT. Enamel demineralization was assessed using the Enamel Decalcification Index (EDI; 0-3). All evaluations were performed by two calibrated, blinded examiners. Statistical analyses were conducted using SPSS (p < 0.05; version 21.0, IBM, Armonk, NY, USA). RESULTS:Posttreatment WSL counts were significantly lower in the maxillary and mandibular anterior regions in the CAT group, with no significant differences in the posterior regions. Although WSLs increased in both groups, the increase was lower after CAT. Total WSL counts were also significantly lower after CAT. In the FAT group, lesion development was more pronounced in the mandibular anterior region. CONCLUSION:CAT was associated with lower WSL burden and fewer newly developed lesions than FAT, particularly in the anterior regions. However, given the observational design, findings should be interpreted as associations rather than causal effects.
PURPOSE:This prospective randomized clinical study aimed to evaluate the effectiveness of maxillary protraction with differently located miniplates combined with intermaxillary elastic applications after corticotomy in patients with skeletal class III malocclusion. METHODS:Twenty patients aged 13-15 years were randomly assigned to one of three groups using a computer-generated random sequence. In the AS and MS groups, an acrylic splint (AS) with hooks in the upper molar region was cemented; the MS group additionally received two palatal miniscrews (MS) for anchorage. In all patients, incomplete Le Fort I osteotomy was performed. Miniplates were placed vertically between the mandibular canine and first premolar in all groups, and horizontally under the osteotomy line in the MP group. Class III elastics were applied 5 days postsurgery and continued until a positive overjet was achieved. Cephalometric radiographs were taken at the beginning of treatment (T0) and at the end of the protraction period (T1). RESULTS:The MP group exhibited the greatest maxillary advancement (3.2 ± 2.2 mm, p < 0.05). Significant B‑point changes occurred in the MP (-1.2 ± 1 mm, p < 0.05) and AS (-0.9 ± 0.9 mm, p < 0.05) groups. The AS group had the largest increase in upper incisor angulation (U1-SN: 5.5° ± 2.5; U1-PP: 4.7° ± 3.3, p < 0.05). All groups showed favorable soft tissue changes; in the MS group the best control of mandibular clockwise rotation was achieved. The duration of protraction period was 5.52 ± 0.9 months for the MP group, 4.84 ± 1.3 months for the AS group, and 4.74 ± 1.18 months for the MS group. CONCLUSION:Although significant improvement was observed in maxillomandibular relations in all groups, the greatest change was observed in the MP group (p < 0.01). The use of skeletal anchorage helped reduce dentoalveolar changes. The MS group was most successful in controlling clockwise rotation of the mandible.
