BACKGROUND:The Malocclusion Impact Questionnaire (MIQ) is a validated tool used to assess how malocclusion affects oral health-related quality of life (OHRQoL). This research focused on translating and culturally adapting the MIQ, then validating it in a group of Arab adolescents with malocclusion. MATERIALS AND METHODS:Following translation per current guidelines, a pilot study with 20 adolescent native Arabic-speakers confirmed the comprehensiveness of the Arabic MIQ (MIQ-AR). The main study included 233 native Arabic-speaking children aged 10-16, who sought initial orthodontic advice. Construct validity was assessed by correlating the total MIQ-AR scale score with responses to global questions. Convergent validity was measured using the Child Perceptions Questionnaire (CPQ11-14 - ISF: 16). Internal consistency and reliability were evaluated using Cronbach's alpha. Forty adolescents completed both questionnaires again after 3 weeks to assess measurement stability, using Spearman's correlation coefficient and the intraclass correlation coefficient. Additionally, principal component analysis (PCA) was conducted. RESULTS:The MIQ-AR demonstrated high internal consistency with Cronbach's α above 0.90 and exhibited a strong Discrimination Index. A positive, strong, significant correlation between the global questions and the total MIQ-AR score supported the construct validity of the MIQ-AR. Convergent validity was confirmed through positive, strong, and statistically significant correlation between the MIQ-AR total scores and the CPQ11-14 scale. The test-retest reliability assessment confirmed the measure's stability over time, and the PCA yielded a two-component solution that accounted for 52.3% of the total variance. CONCLUSION:The current version of MIQ-AR demonstrates strong psychometric properties in terms of validity and reliability, and appears to be a reliable instrument for assessing the impact of malocclusion on OHRQoL among Arab adolescents. However, these findings should be interpreted with caution, as they may be limited to populations like the study sample. Further testing of the measure is required across a variety of settings and further work should evaluate measurement invariance and responsiveness across countries and more representative community samples.

Alterations in the levels of female sex hormones throughout the menstrual cycle can affect bone turnover, which, in turn, may influence the phenomena related to orthodontic tooth movement. The aim of the present study was to investigate in a systematic manner and summarize the existing evidence regarding the interrelationship between the menstrual cycle and the phenomena associated with orthodontic treatment in young females. An unrestricted search was performed. Studies investigating the interdependence between the menstrual cycle in young females and the phenomena associated with tooth movement were reviewed. Study retrieval and selection were followed by extraction of relevant data and risk of bias assessment with the Cochrane ROB 2 tool for randomized controlled studies and the Newcastle-Ottawa Scale for the remaining studies. Finally, seven studies, with variable risk of bias, met the inclusion criteria. Overall, force application during menstruation led to greater tooth movement. Orthodontic pain increased when forces were applied in the luteal phase and was exacerbated when patients presented with primary dysmenorrhea. Orthodontic treatment did not affect the duration of menstrual bleeding or cycle length in the long term. The menstrual cycle may exert an effect on the phenomena associated with orthodontic tooth movement: an orthodontist should therefore be able to identify possible repercussions.

Solitary median maxillary central incisor (SMMCI) syndrome is a rare developmental disorder in which a patient presents with only one upper central incisor located in the midline, along with some other features - such as deviant sella turcica and pituitary gland morphology, panhypopituitarism, hypothyroidism, and hypoplasia of the inner genitals - that may or may not be present. Although some authors consider it a mild manifestation of holoprosencephaly, others classify it as a distinct entity. The aim of this case report is to describe the orthodontic treatment of an 11-year-old female patient with SMMCI. The patient presented with early permanent dentition, Class II, division 2, subdivision (left) malocclusion on a Class I skeletal pattern, a solitary median maxillary central incisor, and moderate crowding in the lower dental arch. Orthodontic treatment was carried out using fixed appliances, involving the creation of space for an additional maxillary central incisor and the correction of Class II malocclusion through the application of intermaxillary elastics. By the end of treatment, Class I canine and molar relationships had been achieved, the overjet and overbite became optimal, and a one-wing Maryland bridge was placed in the area of the left maxillary central incisor. Regarding retention, a lower fixed retainer from canine to canine and upper and lower vacuum-formed appliances were used. In conclusion, this case report highlights the importance of coordinated care among dental specialists for effectively treating solitary median maxillary central incisor cases.

BACKGROUND/OBJECTIVES:Gingival recession results from the displacement of the gingival margin apically to the cementoenamel junction. There is unclear evidence regarding the impact of orthodontic treatment on the development of gingival recessions. The aim of this study was to investigate the changes in clinical crown length and the development of gingival recession on the labial aspect of the maxillary and mandibular incisors associated with orthodontic treatment and relate these changes to the observed variations in their sagittal inclination. MATERIALS/METHODS:Eighty-two consecutive subjects treated with fixed orthodontic appliances in both dental arches, possessing high-quality pre- and post-treatment dental casts and lateral cephalometric radiographs, were selected from the archives of a private orthodontic clinic. Incisor clinical crown lengths before and after orthodontic treatment, as well as the presence or absence of recession, were measured using digitized study models. Changes in sagittal inclination were assessed from lateral cephalometric radiographs and categorized as proclination, retroclination, or no change (± 1°). Spearman's correlation coefficient, one-way analysis of variance, and chi-square tests were utilized for analysis. RESULTS:The mean change in clinical crown lengths for the maxillary incisors ranged from -0.24 to 0.01 mm, while for the mandibular incisors, it varied from 0.06 to 0.10 mm. The inclination changes were -1.78° and 1.03°, respectively, but no correlations were found between these inclination changes and the clinical crown length alterations. Overall, no statistically significant differences were observed in clinical crown length changes concerning the presence of gingival recession among the proclination, retroclination, and no change groups. LIMITATIONS:The sample of this study was retrospective and assessments were carried out immediately post-treatment. CONCLUSIONS/IMPLICATIONS:The alteration of incisor inclination during treatment did not appear to impact the changes in labial clinical crown length and the development of gingival recession in this specific sample.

Background: The immune reactions of patients suffering from chronic allergies and asthma are associated with systemic imbalances that may lead to the overexpression of mediators potentially involved in bone remodeling during orthodontic tooth movement. Aim: The aim of this systematic review was to evaluate the existing evidence from animal studies with regard to the effects of allergen sensitization on the phenomena correlated with orthodontically induced tooth movement. Materials and Methods: This systematic review was based on PRISMA 2020 guidelines. A search without restrictions and hand searching were performed from inception to December 2024. The investigation focused on the impact of allergen sensitization on phenomena associated with orthodontic tooth movement. After the retrieval and selection of relevant studies, data extraction was performed, and the data’s risk of bias was evaluated with the SYRCLE’s Risk of Bias Tool. Results: From the detected records, the inclusion criteria were met by only three studies. At the beginning of tooth movement, periodontal ligament was found to be more compressed in the stress area and more stretched in the tension area in sensitized animals. The amount of tooth movement after 14 days of force application was also greater. However, there were conflicting outcomes regarding root resorption. The risk of bias in the retrieved studies was assessed as high overall. Conclusions: Despite the fact that existing evidence is not directly related to human beings and is based on a limited number of animal studies, allergen sensitization could potentially influence the phenomena associated with orthodontic tooth movement, and orthodontists should be aware of the relevant implications.

Introduction Palatal rugae are used as anatomical landmarks on the hard palate, in various clinical applications; in forensics, for insertion of mini-screws, and for superimposition. There is ambiguous evidence on whether they change during orthodontic treatment and to what extent. Therefore, we investigated changes in the shape, complexity, and area occupied by palatal rugae following orthodontic treatment with and without extractions. Materials and methods Pre- and post-treatment plaster models of maxillae of 28 cases involving first premolar extractions (17 females and 11 males) and 33 non-extraction cases (19 females and 14 males) were scanned and analysed. All participants were selected from a parent sample via discriminant analysis and represent borderline cases. We applied mesh cropping, ball pivoting, distance mapping, contour cropping of rugae, best-fit superimposition, fractal dimension (FD) analysis, and creation of rugae's convex hull area with Viewbox 4 software. The average distance between the closest points of the outlines of pre- and post-treatment palatal rugae (indicating shape change in the set of rugae), disparity in their pre- and post-treatment FDs (reflecting the complexity of their shapes), area occupied by rugae, arch depth, and size of palatal surface were then computed. Results The medians of the average distance between pre- and post-treatment outlines after best-fit superimposition were 0.39 mm (interquartile range [IQR]: 0.34-0.51) and 0.27 mm (IQR: 0.22-0.34) mm for the extraction and non-extraction groups, respectively (P < 0.001). The median pre-treatment FDs were 1.497 (IQR: 1.481-1.521) for the extraction group and 1.481 (IQR: 1.456-1.509) for the non-extraction group, whereas their median post-treatment FDs were 1.502 (IQR: 1.472-1.532) and 1.489 (IQR: 1.469-1.501), respectively. The differences between pre- and post-treatment fractal dimensions were not found to be significant, neither within each group, nor across the groups. On the other hand, the surface area occupied by rugae showed a median increase of 14.7 mm2 (IQR: 0.0-46.5) (P = 0.003) following non-extraction treatment only. Conclusion Palatal rugae change shape during orthodontic treatment, but their shape complexity, as measured by fractal dimensions, remains unaltered. Extraction treatment exerts a more pronounced effect in shape change compared to treatment without extractions. Nevertheless, non-extraction orthodontic treatment increases the surface on which rugae lie, as measured by means of the convex hull. Although the alterations may appear minor, it is necessary to exercise caution and prudence when employing rugae for superimposition and forensic dentistry purposes.

Orthodontic specialty training passed through different phases before it progressed to its today's high standards in content, format, duration, and accreditation. Specialty training, postgraduate and graduate education, accreditation of programs, and recognition of the orthodontic specialty used to be significantly different in the past among countries and regions. However, during the last 30 years a clear tendency for harmonization and uniformity is obvious. The aim of this article is to briefly outline the evolution of the orthodontic specialty training characteristics in different parts of the world and relate them with the recognition, through the years, of the orthodontist as a dental specialist professional. An advanced dental education program in orthodontics and dentofacial orthopedics requires an extensive and comprehensive evidence-based experience, which must be representative of the current didactic and technical changes and advancements in the orthodontic specialty. The wheel should not be reinvented in any country or university in which specialty education is initiated. Excellent standards, accumulated experience, and rich knowledge of postgraduate education are available from different parts of the world, and these must be utilized.

Objective: To assess the surface roughness of in-house 3D-printed orthodontic aligners compared with Invisalign ® appliances, both retrieved as well as in the ‘as-received’ control status. Design: An in vitro study following intra-oral material aging. Setting and participants: Twelve clinically used Invisalign ® appliances and the same number of 3D-printed aligners, without involvement of attachments, were obtained from a respective number of patients. A similar number of ‘as-received’ aligners, of each material, were used as control (CON) groups. Method: Four groups of materials were examined: A = Invisalign ® CON; B = Invisalign ® used; C = 3D-printed CON; and D = 3D-printed used. Optical profilometry was employed to examine the following surface roughness parameters: amplitude parameters Sa, Sq and Sz and functional parameters Sc and Sv. Descriptive statistics and quantile regression modeling were conducted, and the level of statistical significance was set at α = 0.05. Results: Intra-oral exposure of 3D-printed aligners was significantly associated with increase in all tested parameters ( P < 0.001 at all occasions). Significant differences were detected in the retrieved 3D-printed aligners compared with Invisalign ® retrieved, with the exception of Sz. The respective effect sizes (median differences) were as follows: Sa: 169 nm, 95% confidence interval [CI] = 89–248, P < 0.001; Sq: 315 nm, 95% CI = 152–477, P < 0.001; Sc: 233 nm 3 /nm 2 , 95% CI = 131–335, P < 0.001; and Sv: 43 nm 3 /nm 2 , 95% CI = 17–68, P = 0.002. Conclusion: Within the limitations of this study, we concluded that surface roughness differences existed between 3D-printed aligners and Invisalign ® in the retrieved status, as well as between the control and retrieved 3D-printed groups. Keywords 3D-printed , aligners , Invisalign , optical profilometry , roughness , surface characterisation

Background: Orthodontic clear aligners constitute an alternative and increasingly used orthodontic treatment modality, offering enhanced esthetics with potential consequences regarding patients’ oral health-related quality of life (OHRQoL). Objective: Summarize and systematically evaluate existing evidence on the OHRQoL of patients treated with orthodontic clear aligners compared to treatment with conventional metal, fixed appliances. Search methods: We searched without limitations six databases and searched manually the reference lists of relevant studies up to the end of October 2022. Selection criteria: We looked for data from prospective studies that compared OHRQoL, using instruments that had undergone full psychometric validation, between orthodontic patients with clear aligners and labial, fixed, metal orthodontic appliances. Data collection and analysis: We extracted the data from the located studies, and we assessed the risk of bias with the Cochrane Collaboration suggested tools. The quality of available evidence was based on the GRADE approach. Results: Three studies were identified. OHRQoL was impacted less by clear aligners compared to treatment with conventional labially placed, fixed, metal appliances. The exploratory meta-regression, with the time point of assessment as predictor, did not reveal any statistically significant effect. The quality of the available evidence ranged from very low to low. Conclusions: According to the exploratory synthesis of the limited available dataset, treatment with clear aligners could be associated with better OHRQoL ratings compared to treatment with conventional labially placed, metal, fixed appliances. However, the quality of the presented evidence renders further high-quality studies warranted to be able to reach safer conclusions.

Objective: To assess the surface roughness of in-house 3D-printed orthodontic aligners compared with Invisalign® appliances, both retrieved as well as in the ‘as-received’ control status. Design: An in vitro study following intra-oral material aging. Setting and participants: Twelve clinically used Invisalign® appliances and the same number of 3D-printed aligners, without involvement of attachments, were obtained from a respective number of patients. A similar number of ‘as-received’ aligners, of each material, were used as control (CON) groups. Method: Four groups of materials were examined: A = Invisalign® CON; B = Invisalign® used; C = 3D-printed CON; and D = 3D-printed used. Optical profilometry was employed to examine the following surface roughness parameters: amplitude parameters Sa, Sq and Sz and functional parameters Sc and Sv. Descriptive statistics and quantile regression modeling were conducted, and the level of statistical significance was set at α = 0.05. Results: Intra-oral exposure of 3D-printed aligners was significantly associated with increase in all tested parameters (P < 0.001 at all occasions). Significant differences were detected in the retrieved 3D-printed aligners compared with Invisalign® retrieved, with the exception of Sz. The respective effect sizes (median differences) were as follows: Sa: 169 nm, 95% confidence interval [CI] = 89–248, P < 0.001; Sq: 315 nm, 95% CI = 152–477, P < 0.001; Sc: 233 nm3/nm2, 95% CI = 131–335, P < 0.001; and Sv: 43 nm3/nm2, 95% CI = 17–68, P = 0.002. Conclusion: Within the limitations of this study, we concluded that surface roughness differences existed between 3D-printed aligners and Invisalign® in the retrieved status, as well as between the control and retrieved 3D-printed groups.

BACKGROUND:Removal of maxillary primary canines and other interceptive treatment modalities in the mixed dentition have been suggested as methods used to increase the rate of normal eruption of palatally displaced permanent canines (PDCs). However, the information on the overall effect on PDCs' position has been inconclusive.OBJECTIVE:To assess whether this practice improves the position of PDCs and to investigate the quality of the evidence.SEARCH METHODS:Unrestricted searches in 7 databases and manual searching of the reference lists in relevant studies were performed up to June 2022 (Medline via PubMed, CENTRAL, Cochrane Database of Systematic Reviews, Scopus, Web of Science, ClinicalTrials.gov, ProQuest Dissertations, and Theses Global).SELECTION CRITERIA:We looked for data on the positional changes of PDCs (mesial inclination, vertical position, canine crown cusp tip to midline) from randomized controlled trials assessing the various interceptive treatment modalities.DATA COLLECTION AND ANALYSIS:Following study retrieval and selection, relevant data were extracted, and the risk of bias was assessed using the Cochrane Risk of Bias 2 Tool. Exploratory synthesis and meta-regression were conducted using the random effects model and the overall quality of the available evidence was assessed with the Grades of Recommendation, Assessment, Development, and Evaluation approach.RESULTS:Five studies (3 at low risk of bias) were identified, involving 238 individuals, followed for up to 18 months post-intervention with OPG (orthopantomogram) or CBCT (cone-beam computed tomography). Exploratory data synthesis showed that PDCs' position improved more in the extraction sites compared to non-extraction. Analysis of the studies at low risk confirmed the above observations (6- and 12-month). Improvements were observed in patients using headgear after extraction of primary canines compared to extraction alone, but not in patients with double extraction of primary canines and first molars. The quality of available evidence was rated at best as moderate.CONCLUSIONS:Interceptive treatment modalities in the mixed dentition may improve the position of PDCs. However, more studies are necessary in order to determine the clinical significance of the changes.REGISTRATION:PROSPERO (CRD42015029130).

Advanced dental education programs in orthodontics and dentofacial orthopedics require an extensive and comprehensive evidence-based experience, which must be representative of the current didactic and technical advancements. Over the past 25 years, the World Federation of Orthodontists (WFO) has placed emphasis in the support for the recognized orthodontic specialty training programs in every region of the world. In its early years, the WFO developed general principles for specialty education that culminated in the first comprehensive curriculum recommendations, i.e., the WFO Guidelines for Postgraduate Orthodontic Education, which was published in February 2009. In view of the significant changes in the specialty of orthodontics, the WFO has revised and updated its previous document to reflect the expanded scope and demands of current orthodontic education and practice. The members of the task force participated in a thorough revision of the guidelines and created a new document that takes into consideration the didactic, clinical, and the appropriate physical facilities to provide clinical care, study, and research areas. Although it is recognized that there will be variations in teaching and faculty assets, as well as facilities, access to materials, and equipment, the aim of the WFO Educational Guidelines is to provide the minimum program requirements necessary to provide orthodontic specialty residents the educational experience that prepares them to deliver the best level of orthodontic treatment for their patients. It is recommended that these guidelines be used universally by orthodontic specialty program educators and related educational, scientific, and administrative institutions to evaluate and compare their curriculum to a world standard.

ObjectiveThe aim of this study is to systematically investigate the available evidence from human studies regarding the association of asthma and/or allergy with EARR. Materials and methodsUnrestricted searches in 6 databases and manual searching were performed up to May 2022. We looked for data on EARR after orthodontic treatment in patients with/without asthma or allergy. Relevant data were extracted, and the risk of bias was assessed. An exploratory synthesis was carried out using the random effects model, and the overall quality of the evidence was assessed with the Grades of Recommendation, Assessment, Development, and Evaluation. ResultsFrom the initially retrieved records, nine studies met the inclusion criteria (three cohort and six case-control). Overall, increased EARR was observed in the individuals with allergies in their medical history (Standardised Mean Difference [SMD]: 0.42, 95% Confidence Interval [CI]: 0.19 to 0.64). No difference in EARR development was observed among individuals with or without a medical history of asthma (SMD: 0.20, 95% CI: -0.06 to 0.46). The quality of available evidence, excluding studies at high risk, was rated as moderate for the exposure to allergy, and low for the exposure to asthma. ConclusionIncreased EARR was noted in individuals with allergies compared to the control group, while no difference was observed for individuals with asthma. Until more data become available, good practice would suggest that it is important to identify patients with asthma or allergy and consider the possible implications.

AIM:To assess whether the efficacy of external tooth bleaching differs between untreated and orthodontically treated teeth.MATERIALS AND METHOD:Three groups of subjects were formed; group Debonded included 24 consecutive orthodontically treated patients evaluated immediately after removal of fixed appliances. The Retention group included 24 consecutive orthodontically treated patients in the phase of retention. The Untreated group consisted of 24 arbitrarily selected undergraduate dental students without history of fixed-appliances orthodontic therapy. Each of the above three groups was further randomized into two subgroups, Bleaching and Placebo. Each subgroup received either a 38% hydrogen peroxide bleaching treatment or a placebo agent, respectively. Tooth colour changes were assessed at seven timepoints: 1 day before intervention; on the day of intervention before and after treatment; and at 7, 14, 21, and 90 days for parameters L*, a*, b*, and ΔΕ in all upper incisors and canines with the use of a reflectance spectrophotometer. Intra-rater agreement was estimated with the Intra-class Correlation Coefficient and method's error was calculated using the Repeatability Coefficient. Regarding tooth colour changes, an analysis of variance was used to assess differences between groups.RESULTS:Bleaching was associated with an increase of the L* value and decrease of b* and a* values in both orthodontically treated and untreated teeth. Parameters ΔE, L*, and b* exhibited statistically significant differences between the Bleaching-Untreated and Bleaching-Retention subgroups. In the Bleaching subgroups, statistically significant differences were found between different teeth for all parameters.CONCLUSIONS:Previous exposure to fixed orthodontic appliance influenced the efficacy of external tooth bleaching. The effect of bleaching was higher after orthodontic treatment and with longer period in retention. Canines changed in colour more than incisors, and the effect was reduced over time.

Palatal rugae constitute significant morphological landmarks, with wide clinical applications in forensics, insertion of mini-screws, and superimposition. Their morphology has been studied mainly with indices relevant to their qualitative characteristics. The present paper aims at presenting a new quantitative method to evaluate their complexity, by means of box-counting fractal dimension analysis, and to investigate its inter- and intra-rater reliability. Twenty maxillary plaster models were scanned for the needs of this study. A sequence of steps, including cropping of the mesh, ball pivoting, distance mapping and fractal dimension analysis, performed with Viewbox 4 software, was followed. Box-counting fractal dimensions were calculated as a measure of rugae’s complexity. Inter- and intra-rater reliability were investigated, using Bland–Altman analysis. Fractal dimensions ranged from 1.274 to 1.491 (average: 1.412). Bland–Altman analysis of inter- and intra-examiner reliability demonstrated that the 95% limits of agreement ranged from − 0.012 to 0.011 and from − 0.004 to 0.004, respectively. The method is reliable and can be applied in research and forensics. It offers comprehensive evaluation of the rugae’s complexity and a complete set of information about their outlines and height profiles, with minimum user intervention.

The article reviews the ageing changes of the midfacial and maxillary bones, the mandible, the overlaying soft tissues and the smile, and presents clinical guidelines aiming to rejuvenate older faces by means of orthodontic therapy. With regard to the ageing changes, the maxillary skeleton appears to rotate clockwise inferior to the orbit and becomes retrusive, and as a general pattern the midface contracts and deteriorates with age. Resorption below the mental foramen, reduction in alveolar height, loss of bone at the chin region, and relative increase in size and shape are signs of an aged mandible. Epidermal thinning and decrease in collagen in combination with the effect of gravity and various external factors contribute to the ageing of the skin. Atrophy of the superficial and deep fat, changes in ligamentous tissues and changes in muscle structure, position and tone, all contribute to the stigmata of the aged face. In the article, two late adulthood orthodontic cases are discussed as examples, and general guidelines for orthodontic management of the older face aiming at reversing the 'shrinkage' of the tissues by restoring the facial shape and tightening the soft tissue mask are described. The possible mechanisms explaining the changes observed on the faces of the clinical cases are also discussed. A properly planned and executed orthodontic intervention reversing changes from the inside-out before embarking on cosmetic surgery might have a synergistic effect multiplying the benefits for adult patients.

INTRODUCTION:Extraction of primary maxillary canines in the mixed dentition has been suggested to increase the rate of normal eruption of displaced permanent canines (DPCs). In this study we assessed whether extracting multiple primary teeth increases the rate of normal eruption of DPCs positioned palatally or centrally in the alveolar crest.METHODS:Unrestricted searches in 8 databases were performed up to March 2021. We looked for data on the prevalence of physiologic eruption of DPCs and the changes in their position from randomized controlled trials. The risk of bias was assessed using the Cochrane Risk of Bias 2 Tool. Exploratory synthesis was carried out using the random effects model.RESULTS:Three studies (at low risk of bias) were identified, involving 128 individuals, followed for up to 48 months. The double extraction did not result in a benefit regarding successful eruption at 24 months follow-up, nor the change in position after 14.8 months. However, after 48 months the double extraction was beneficial (Risk Ratio: 1.17; 95% Confidence Interval: 1.05 to 1.30, P=0.005). Moreover, after 18 months, the DPCs' position improved more in the double extraction sites.CONCLUSIONS:While the extraction of the deciduous canine and first molar does not increase the chance of normal eruption nor improves the position of DPCs in shorter follow-ups, it might confer a benefit after a longer period of observation. Further studies are warranted in order to clarify the magnitude and clinical significance of any potential benefit and provide guidance to clinical decisions.