Introduction White spot lesions (WSLs) are a common adverse outcome of fixed orthodontic treatment, prompting the search for salivary microbial predictors for early risk identification.Materials and methods Sixty-four patients undergoing fixed metal self-ligating orthodontic treatment were categorized into WSL and non-WSL groups based on lesion development after 12 months. Clinical indices (DI-S, CI-S, OHI-S, GI) and unstimulated whole saliva samples were collected at baseline and after 12 months. The salivary microbiome was analyzed using 16S rRNA gene sequencing.Results The prevalence of WSLs was 54.7% at the patient level. Clinical indices did not differ significantly between groups. Although overall microbial community structure was similar at baseline, several taxa were enriched in patients who later developed WSLs, including Actinomyces, Rothia and Granulicatella. After 12 months, the WSL group showed reduced phylogenetic diversity and a microbial profile enriched in acidogenic and anaerobic taxa. Functional prediction indicated increased carbohydrate metabolism and fermentative pathways in WSL patients.Conclusions WSL development during fixed orthodontic treatment was associated with baseline salivary microbial differences and treatment-related ecological shifts. Salivary microbiome profiling may help identify patients at higher risk and support early risk stratification and preventive strategies in orthodontic care.

Craniofacial growth patterns and upper airway dimensions have been reported to be associated, but evidence regarding differences in airway morphology across growth patterns between different time periods remains limited. This study compared two independent adolescent samples collected in 2005 and 2020 to determine whether differences in upper airway morphology varied across craniofacial growth patterns. In this retrospective cross-sectional cephalometric study, 360 pre-orthodontic lateral cephalograms (180 from 2005; 180 from 2020) of Han Chinese adolescents (aged 10–15 years) from Hangzhou were analyzed. Cephalometric landmarks were used to identify growth patterns (vertical/horizontal/average) and to measure sagittal airway widths (nasopharyngeal: PNS-UPW, PNS-AD2; oropharyngeal: U-MPW; glossopharyngeal: TB-TPPW; laryngopharyngeal: V-LPW) and adenoid-nasopharyngeal ratios (A/N). Multivariate analysis of covariance (MANCOVA) adjusted for age, sex, and sagittal skeletal pattern was used to evaluate the effects of year, growth pattern, and their interaction. Adjusted mean differences with 95

Introduction Orthodontic tooth movement (OTM) relies on mechanical force that triggers inflammatory responses in periodontal tissue, orchestrating alveolar bone remodeling. Potassium (K+) efflux plays a key role in inflammation and tissue remodeling. The calcium-activated potassium channel KCNN4 regulates immune responses, but its role in inflammatory signaling in periodontal ligament cells (PDLCs) under mechanical stress remains unclear. Objectives This study aimed to investigate how mechanical force activates KCNN4 and regulates downstream inflammatory signaling in PDLCs. Methods Human PDLCs (hPDLCs) were subjected to compressive force in vitro. KCNN4, FOXO1, and USP46 were interfered with using pharmacological inhibition (senicapoc) or siRNA-mediated knockdown. Potassium and calcium fluxes, NLRP3 inflammasome activation, and downstream cytokine expression were assessed via fluorescence imaging, western blotting, qPCR, and immunoprecipitation. Chromatin immunoprecipitation and RNA-seq analyses were performed to identify transcriptional regulators of USP46. Conditioned medium from hPDLCs was applied to THP-1-derived macrophages to evaluate macrophage inflammatory polarization. In vivo, a rat OTM model was used to examine alveolar bone remodeling and local inflammation under KCNN4 inhibition. TRAP staining, immunohistochemistry, and immunofluorescence to evaluate osteoclast activity and NLRP3-mediated inflammatory signaling in the periodontal ligament. Results Mechanical force induced KCNN4-mediated K+ efflux in hPDLCs, promoting FOXO1 dephosphorylation and nuclear translocation. Activated FOXO1 transcriptionally upregulated the deubiquitinase USP46, which in turn deubiquitinated NLRP3, leading to inflammasome activation. Inhibition of KCNN4, FOXO1, or USP46 attenuated NLRP3 activation and downstream IL-1β maturation. Conditioned medium experiments demonstrated that this signaling cascade promoted macrophage inflammatory activation, while senicapoc reversed these effects. In vivo, KCNN4 inhibition suppressed local NLRP3-mediated inflammation, reduced osteoclast differentiation on the pressure side, and attenuated OTM. Conclusions Our findings reveal a mechanotransduction axis in PDLCs whereby mechanical force activates KCNN4, driving FOXO1-dependent USP46 transcription and NLRP3 inflammasome activation. This signaling cascade translates transient mechanical stimuli into an inflammatory cascade, triggering macrophage-mediated alveolar bone remodeling during OTM. Importantly, KCNN4 is required for proper inflammatory responses and OTM, highlighting its potential role in orthodontic therapy

Aim or purpose: The high-fat environment impairs osteoblast function and activates lipophagy; however, promoting lipophagy may improve osteogenesis under certain conditions. The underlying mechanisms are unclear. Our study investigated whether Rab18 interacting with OPTN is involved in regulating lipophagy of osteoblasts in high-fat environments, thereby affecting the osteogenic function. Materials and methods: Primary mouse osteoblasts were cultured with/without high-fat medium. The lipid in osteoblasts was observed by Oil Red O staining and Bodipy493/503. The level of autophagy was examined by western blot (WB) and observed by immunofluorescence staining and transmission electron microscopy (TEM). Alkaline phosphatase (ALP) staining and WB were used to measure the osteogenesis level. OPTN and Rab18 protein expression in cells treated with/without Baf-A1 were examined by WB. OPTN-Rab18 protein interactions were verified by immunoprecipitation (Co-IP), and were visualized by immunofluorescence co-localization staining. All data were expressed as mean ± standard deviations (SD) in at least three independent measurements. A one-way ANOVA collapsed to a t-test when there were only two groups. Statistical significance was considered to be at a p-value of <0.05. Results: High-fat medium decreased osteogenic indicators and reduced OPTN-Rab18 protein interactions. The absence of OPTN and Rab18 further impaired osteoblast biologic function. Rab18 activation improved OPTN-Rab18 protein interactions and ameliorated high-fat-induced osteogenesis impairment. Conclusions: High-fat environment may regulate lipophagy in osteoblasts by impairing protein interactions between OPTN and Rab18, thereby affecting osteogenesis. Facilitation of OPTN-Rab18 interactions may modulate osteoblast lipophagy and improve osteogenesis.

INTRODUCTION:This retrospective cone-beam computed tomography (CBCT) study aimed to analyze the associations between maxillary palatally displaced canine (PDC) with the craniofacial and atlas vertebra structures. METHODS:A total of 94 patients (47 with PDC and 47 normal) were included. Then, their CBCT data were reconstructed and analyzed to measure the 3-dimensional angular positions of canines, the structures of sella turcica, atlas vertebra, and cranial base. Comparisons of continuous variables between 2 groups were performed using the independent samples t test or the Mann-Whitney U test, whereas 1-way analysis of variance or Kruskal-Wallis tests were used for comparisons among multiple groups. Categorical variables were compared using the chi-square test or Fisher exact test, as appropriate. Binary logistic regression analyses, along with Spearman or Pearson correlation analyses, were conducted to determine the associations between variables. RESULTS:No significant differences were observed in sella turcica structures or the occurrence of ponticulus posticus between the 2 groups (P >0.05). The anterior cranial base length was significantly smaller, and the cranial base angle was significantly larger in subjects with PDC (P <0.05). Moreover, a significant negative correlation was identified between anterior cranial base length and the occurrence of PDC (P <0.05). However, the angular positions of canines showed no significant correlation with any craniofacial variables. CONCLUSIONS:On the basis of CBCT data, the structures of sella turcica and atlas vertebra did not differ between patients with PDC and those with normally erupted canines. However, patients with PDC exhibited a significantly shorter anterior cranial base length and a greater cranial base angle, suggesting a possible developmental link between cranial base morphology and maxillary canines. The explicit relationship and clinical significance of PDC with craniofacial structures require further investigation.

INTRODUCTION:This study aimed to evaluate the biomechanical effects of different initial mesiodistal inclinations of posterior teeth during extraction space closure using clear aligner treatment. METHODS:Three different finite element models were developed for first premolar extractions, each representing different initial mesiodistal inclinations of the posterior teeth: model 1 with 15° mesial inclination, model 2 with upright posterior teeth, and model 3 with 10° distal inclination. A total of 12 en-masse retraction aligner models with varying posterior antitipping designs (0°, 1°, 2°, and 3°) were constructed to simulate space closure. RESULTS:From models 1 to 3: Sagittally, posterior teeth increased mesial crown movement but decreased distal root movement; vertically, posterior teeth reduced crown intrusion but enhanced root intrusion; the posterior rotation center shifted distally and apically. Horizontally, model 3 indicated the greatest mesiolingual rotation of posterior teeth across all models. For anterior teeth, model 1 exhibited the most incisor retraction and lingual tipping, whereas model 3 displayed the least incisor retraction and lingual tipping. In addition, the progressive posterior antitipping design gradually diminished both the mesial tipping of posterior teeth and the lingual tipping of anterior teeth. CONCLUSIONS:Different mesiodistal inclinations of posterior teeth had various biomechanical effects in 3 dimensions during space closure. Careful consideration should be given to the mesiodistal angulation of posterior teeth during extraction space closure with aligners.

Objective:: Alveolar bone loss is a common adverse effect of intrusion treatment. Mandibular incisors are prone to dehiscence and fenestrations as they suffer from thinner alveolar bone thickness. Methods:: Thirty skeletal class II patients treated with mandibular intrusion arch therapy were included in this study. Lateral cephalograms and cone-beam computed tomography images were taken before treatment (T1) and immediately after intrusion arch removal (T2) to evaluate the tooth displacement and the alveolar bone changes. Pearson's and Spearman's correlation was used to identify risk factors of alveolar bone loss during the intrusion treatment. Results:: Deep overbite was successfully corrected (P < 0.05), accompanied by mandibular incisor proclination (P < 0.05). There were no statistically significant change in the true incisor intrusion (P > 0.05). The labial and lingual vertical alveolar bone levels showed a significant decrease (P < 0.05). The alveolar bone is thinning in the labial crestal area and lingual apical area (P < 0.05); accompanied by thickening in the labial apical area (P < 0.05). Proclined incisors, non-extraction treatment, and increased A point-nasion-B point (ANB) degree were positively correlated with alveolar bone loss. Conclusions:: While the mandibular intrusion arch effectively corrected the deep overbite, it did cause some unwanted incisor labial tipping/flaring. During the intrusion treatment, the alveolar bone underwent corresponding changes, which was thinning in the labial crestal area and thickening in the labial apical area vice versa. And increased axis change of incisors, non-extraction treatment, and increased ANB were identified as risk factors for alveolar bone loss in patients with mandibular intrusion therapy.

Objective To evaluate the biomechanical effects of en-masse versus substep extraction space closure on posterior teeth during clear aligner treatment and to provide guidelines for optimising anti-tipping designs.Methods Twenty-four maxillary finite element models incorporating first premolar extractions treated by clear aligners were constructed. The models were divided into two groups: en-masse closure (I0, en-masse retraction; II0, en-masse mesialisation), and substep closure (Ia, canine distalisation; Ib, incisor retraction; IIa, premolar mesialisation; IIb, molar mesialisation). Within each group, different anti-tipping designs (1 degrees, 2 degrees, 3 degrees) were applied to the posterior teeth.Results Compared to I0, groups Ia, Ib, and Ia+b exhibited less crown mesial displacement, root distal displacement, and mesial tipping of the posterior teeth. In contrast, groups IIa, IIb, and IIa+b demonstrated more crown mesial displacement, root distal displacement, and mesial tipping. Of note, IIa increased the mesial movement of the premolars and generated a distal force on the molars, mitigating their mesial inclination. IIb had a similar effect. Consequently, Ia, Ib, and Ia+b required significantly less anti-tipping design to maintain the pretreatment mesiodistal angulation of the posterior teeth. Conversely, IIa, IIb, and IIa+b necessitated more anti-tipping design to achieve bodily movement of the posterior teeth.Conclusion Substep retraction may reduce the mesial tipping and anti-tipping design of the posterior teeth. Substep mesialisation, however, may increase crown displacement, posterior mesial tipping, and the anti-tipping design; nevertheless, the reaction forces from adjacent teeth can partially alleviate these effects. Further clinical validation is necessary to confirm these findings.

OBJECTIVE:To evaluate the biomechanical effect of anterior and posterior teeth in en-masse retraction in lingual orthodontics using varied archwire sizes and lever arm lengths. METHODS:A finite element model of lingual orthodontics for retracting maxillary anterior teeth was established. The archwire was designed into: Archwire 1: 0.016×0.022-inch stainless steel (SS) with 15° extra torque on central incisors, Archwire 2: 0.016×0.024-inch SS with 13° extra torque on anterior teeth, Archwire 3: 0.017×0.025-inch SS with laterally 0.016×0.024-inch, and Archwire 4: 0.018×0.025-inch SS with laterally 0.016×0.0225-inch. Moreover, the lever arm was set to 0mm, 2mm, 4mm, 6mm, 8mm, and 10mm. Initial displacements were calculated after applying 1.5N force from mini-implant to lever arms. RESULTS:In Archwire 1, increasing intrusion and labial tipping on central incisors and decreasing lingual tipping on lateral incisors and canines, as well as decreasing palatal tipping and distal inclination on posterior teeth were observed with lever arm length increase. In Archwire 2, with the lever arm length increase, incisors exhibited increasing labial tipping, while palatal inclination and intrusion of posterior teeth decreased. In Archwire 3 and 4, torque control ability of anterior teeth increased with longer lever arms, as well as decreasing extrusion was observed on central incisors. Posterior teeth moved buccally and distally. CONCLUSIONS:Thick archwire without extra torque combined with longer lever arm are more conducive to en-masse retraction of central incisor. Moreover, extra torque on thinner archwire can also effectively control torque. Besides, additional torque and lever arm lengths affect the movement of posterior teeth.

During orthodontic treatment,irregular and varying sized nodular bony protrusions may sometimes appear on the labial side of the patient's anterior alveolar bone,which is closely related to the differential bone remodeling on the inner and outer surfaces of the alveolar bone.Labial protuberances not only affect the aesthetic results of orthodontic treatment,but also pose potential risks to periodontal health.Currently,it is believed that the influencing factors of the formation of the labial protuberances may be related to the patient's gender and age,tooth movement speed,and extent of anterior teeth retraction.Labial protuberances typically resolve spontaneously,however,if persistent,alveoloplasty may be necessary for treatment.This review provides a summary on the occurrence,influencing factors of formation,potential biological mechanisms,and corresponding treatment methods of labial protuberances during orthodontic treatment.

Craniofacial deformity and malocclusion are primary concerns following temporomandibular joint ankylosis (TMJa) in growing patients, and they pose even greater challenges in adult patients. The treatment objectives always involve restoring proper jawbone structure, achieving stable occlusion, and attaining satisfactory joint mobility. This report presents a 4-year follow-up of an adult patient with TMJa-induced mandibular deviation, who underwent a combined treatment approach involving distraction osteogenesis (DO) and orthodontic–orthognathic surgery. Orthodontic treatment resulted in favorable occlusion and improved facial esthetics. A new condyle with a reconstructed glenoid fossa in a forward position was established after mandibular DO and the damaged TMJ experienced self-remodeling owing to functional improvement. Thus, this case demonstrates the efficacy of DO in promoting adaptive TMJ self-remodeling with long-term stability when treating mandibular deviation caused by condylar ankylosis in adult patients.

Occlusal plane (OP) is one of the essential factors affecting craniofacial morphology and function. The OP not only assists in diagnosing malocclusion but also serves as an important reference for making treatment plans. Patients with different types of malocclusions have different forms of OP. Compared with patients with standard skeletal facial type, the occlusal plane of patients with skeletal class Ⅱ and high angle is steeper, while that of patients with skeletal class Ⅲ and low angle is more even. In orthodontic treatment, adjusting and controlling the OP can promote the normal growth and development of the mandible in most patients with malocclusion during the early stage of growth, while causing favorable rotation of the mandible in some adults with mild-to-moderate malocclusion. For moderate-to-severe malocclusion, the OP rotation by orthodontic-orthognathic treatment can achieve better long-term stability. This article reviews the evolution of the definition of OP and its implications for diagnosing and the guiding treatment of malocclusion.平面是影响口颌系统功能及形态的重要因素之一。 平面不仅能协助错 畸形的诊断，也是制订正畸治疗方案的重要参考因素。不同类型的错 畸形患者 平面表现形式不同，骨性Ⅱ类、高角患者的 平面比正常骨面型患者陡峭，骨性Ⅲ类、低角患者的 平面则相对平坦。通过调整和控制 平面可促进大多数处于生长发育期及其前期的错 畸形患者下颌正常生长发育，也可使部分轻中度错 畸形成人患者的下颌发生有利旋转，从而获得良好的治疗效果。重度骨性错 畸形患者通过正畸-正颌治疗旋转 平面可使其获得更好更稳定的长期效果。本文从 平面定义的演变、 平面对错 畸形判断的意义以及 平面在错 畸形治疗中的指导作用等方面作一综述，以期为临床正畸治疗提供参考。.

Occlusal plane (OP) is one of the essential factors affecting craniofacial morphology and function. The OP not only assists in diagnosing malocclusion but also serves as an important reference for making treatment plans. Patients with different types of malocclusions have different forms of OP. Compared with patients with standard skeletal facial type, the occlusal plane of patients with skeletal class Ⅱ and high angle is steeper, while that of patients with skeletal class Ⅲ and low angle is more even. In orthodontic treatment, adjusting and controlling the OP can promote the normal growth and development of the mandible in most patients with malocclusion during the early stage of growth, while causing favorable rotation of the mandible in some adults with mild-to-moderate malocclusion. For moderate-to-severe malocclusion, the OP rotation by orthodontic-orthognathic treatment can achieve better long-term stability. This article reviews the evolution of the definition of OP and its implications for diagnosing and the guiding treatment of malocclusion.

ObjectiveTo evaluate the effects of rapid maxillary expansion (RME) on mid-facial depth in early mixed dentition and to investigate the relationship between change in mid-facial depth and maxillary sinus and nasal cavity.MethodsA total of 35 patients with mixed dentition treated with a Haas expander were included in this retrospective study. All patients underwent a cone-beam computed tomography scan before and after rapid maxillary expansion. The Wilcoxon signed-rank test was performed to evaluate the changes in maxillary width, facial depth, maxillary sinus, and nasal cavity volume before and after expansion. Multiple linear regression analysis was applied to evaluate the correlations among them.ResultsThe hard and soft tissue facial depth in the middle third increased significantly (P < 0.001). The gain on the outer sagittal plane (1.04–1.52 mm) was slightly bigger than that on the inner sagittal plane (0.91–1.30 mm). Maxillary width and nasal cavity width increased 3.42 ± 0.93 mm (P < 0.001) and 2.25 ± 0.77 mm (P < 0.001), respectively, after treatment. A gain was also achieved in both nasal cavity volume (2,236.15 mm3, P < 0.001) and maxillary sinus volume (1,227.33 mm3, P < 0.001). Multiple linear regression analysis showed that with the increase in maxillary sinus volume, the facial depth increased as well (B = 0.455–0.683, P < 0.05). Also, statistically significant correlations were found between nasal width and nasal cavity volume (B = 0.384, P < 0.05).ConclusionThe depth of the middle third face increased significantly. The facial depth increase was related to the enlargement of maxillary sinus volume, while the nasal cavity volume gain was related to the nasal width increase. This indicated that RME might enhance the fullness of the mid-face and facilitate the patency of nose breathing.

无托槽隐形矫治器在推上颌磨牙远中移动方面具有显著优势.但由于上颌解剖结构不同及患者依从性差异等因素,上颌磨牙远中移动的实际移动量与设计移动量间存在一定差异,影响最终矫治效果.该文就患者基本情况、上颌磨牙及周围解剖结构、方案设计方面进行综述,以期为正畸医生设计上颌磨牙远移方案提供参考依据,并提高远移实现效率.

Abstract Background: Speech sound disorders are produced irrespective of the type of orthodontic appliance. The present systematic review aimed to compare the speech impediments created during orthodontic treatment with the labial appliances (LA), lingual appliances (LI), and orthodontic aligners (OA). Methods: The studies were searched from PubMed, Scopus, Web of Science, Embase, and Cochrane Library from 2000 to 25 Feb 2022. A manual search was also performed. The study’s quality was assessed by the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Quality Assessment Form. Two reviewers performed study selection and data extraction. Results: From a total of 1298 articles, 21 studies were selected, including 3 randomized clinical trials (RCTs), 15 prospective studies, 2 retrospective studies, and 1 cross-sectional study. Two RCTs were assessed as having a "low" risk of bias, and one was considered unclear. Twelve nonrandomized studies were classified as "high" and six as "moderate" quality. Six studies compared LA and LI, three studies compared LA and OA, one study compared LI and OA, and eleven studies only evaluated single orthodontic appliances. Conclusion: Based on the evidence available, LA seemed to impact minimally on speech, and the duration was the shortest; LI caused more speech impediments and had greater difficulty adapting; OA produced mild to moderate speech impediments, and the adaptation time was between the two.

Since distraction osteogenesis had been used in maxillofacial surgery in the 1990s,it has become an important option for treating maxillary hypoplasia in cleft lip and palate (CLP) patients. Numerous domestic and international studies reported that the prognosis of distraction osteogenesis might be affected by various factors, including the design of osteotomy line, type of distractor, advancement of maxillary bone and the age of patients, etc. Therefore, the present article reviewed possible impact factors that affect the effectiveness and outcomes of maxillary distraction osteogenesis of CLP from three aspects: treatment methods, type of patients and adjuvant therapy, which hopefully might benefit the formulation of treatment strategies in clinical work and improve the prognosis of distraction osteogenesis.

目的:探讨TBL(team-based learning)应用于妇科临床病史采集教学中的效果.方法:选取2019年8月至2020年8月在妇科见习的临床医学专业2个班级共102名学生,A班52名为对照组,采用传统教学模式;B班50名为TBL组,分为12小组,采用TBL教学模式,每小组4～5名学生,每小组至少2名女生.教学后结合临床病例测验学生病史采集能力,并进行教学满意度问卷调查,分析教学效果.结果:TBL组中学生临床病史采集总分(18.66±1.94)明显高于对照组(15.94±2.66)(P<0.05),教学满意度调查显示TBL教学模式总分(29.62±3.37)明显高于传统教学模式(25.13±4.68)(P<0.05).结论:TBL教学方法可提高学生的妇科病史采集能力,并获得良好的教学满意度.

目的 探讨多学科协作模式下的ICU多重耐药菌感染防控策略的构建与应用效果.方法 选取2018年5月-10月ICU收治的598例患者作为对照组、实施常规多重耐药菌感染防控管理,2019年5月-10月ICU收治的619例患者作为观察组,实施多学科协作模式的多重耐药菌感染防控策略.比较两组多重耐药菌感染防控措施落实率、环境卫生监测合格率及多重耐药菌感染率.结果 观察组的手卫生、防护措施及隔离措施的多重耐药菌感染防控措施落实率分别为89.64％、95.48％及96.97％,均高于对照组的76.78％、92.83％及78.33％;医疗用品表面、环境及消毒物品、床单元表面的环境卫生监测合格率分别为96.12％、96.23％及96.28％,均高于对照组的73.30％、72.41％及71.40％;多重耐药菌感染率为5.33％低于对照组的10.03％,差异具有统计学意义(p＜0.05).结论 多学科协作模式下的ICU多重耐药菌感染防控策略的构建与实施,能够有效提升多重耐药菌感染防控措施落实率及环境卫生监测合格率,降低多重耐药菌感染率,提高ICU多重耐药菌感染的防控效果.

目的:探讨感染性疾病科病房消毒隔离制度的构建方法与成效.方法:感染性疾病科自2019年3月起构建消毒隔离制度,强调标准预防概念,加强患者的消毒隔离管理工作,完善各项规章制度,加强病房环境管理,比较管理方案实施前后6个月内感染性疾病科的消毒隔离管理质量评分,以及护士的消毒隔离制度执行情况.结果:实施后医疗废物处理、感染监控、环境管理、管路管理、感染防护评分均显著高于实施前(P＜0.05),护士的消毒隔离制度执行率、手卫生执行率、环境维护合格率、器械消毒合格率均显著高于实施前(P＜0.05).结论:构建感染性疾病科病房消毒隔离制度,能够有效提升护理管理质量,提高护士对消毒隔离制度的执行率.