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Orthodontics: Current Clinical Status and Future Challenges
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Orthodontics: Current Clinical Status and Future Challenges

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Dentistry, Oral Surgery and Oral Medicine".

Deadline for manuscript submissions: closed (20 October 2023) | Viewed by 20594

Special Issue Editors

Prof. Dr. Anne Marie Kuijpers-Jagtman

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Guest Editor
1. Department of Orthodontics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
2. Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine/Medical Faculty, University of Bern, Bern, Switzerland
3. Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia
Interests: translational and clinical research in orthodontics; orthodontic tooth movement; cleft lip and palate; craniofacial anomalies; 3D-imaging of the craniofacial complex
Prof. Dr. Stavros Kiliaridis

E-Mail Website
Guest Editor
1. Division of orthodontics, University clinics of dental medicine, University of Geneva, Geneva, Switzerland
2. Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine/Medical Faculty, University of Bern, Bern, Switzerland
Interests: functional factors influencing craniofacial growth; postemergent tooth eruption; masticatory muscles physiology; neuromuscular disorders and orthodontics; orthodontic treatment under the light of functional factors
Dr. Ewald M. Bronkhorst

E-Mail Website
Guest Editor
Department of Dentistry, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
Interests: cleft lip and palate; velopharyngeal insufficiency; biostatistics and epidemiology

Special Issue Information

Dear Colleagues,

Orthodontics has developed rapidly over the last 20 years. The turning point is the rise of digital orthodontics and the increasing interest of the public in the new possibilities, which influenced the demand for orthodontic treatment as well. Besides this, interdisciplinary orthodontics became an expanding field, and it extended the boundaries within which orthodontics had taken place in the past. This also benefits immensely the treatment of patients with orofacial clefts and craniofacial anomalies.

This special issue focuses on the current status and future challenges in orthodontics, and more in particular orthodontic diagnostics, treatment planning, and treatment outcome. The context may be the patient’s perspective as well as the professional’s perspective. We also encourage submissions regarding translational research in the field of orthodontics and craniofacial orthodontics that have the potential to change orthodontics of tomorrow and elucidate on challenges in the next decade or so.

On behalf of the Journal of Clinical Medicine, you are cordially invited to contribute an article to the Special Issue “Orthodontics: Current Clinical Status and Future Challenges.” Research articles, systematic and comprehensive reviews, and short communications are welcome to submit. Case reports and short/mini reviews will not be considered.

Prof. Dr. Anne Marie Kuijpers-Jagtman
Prof. Dr. Stavros Kiliaridis
Dr. Ewald M. Bronkhorst
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • orthodontics
  • craniofacial deformity
  • craniofacial orthodontics
  • treatment methods
  • treatment outcome
  • patient centered outcomes research
  • orthodontic tooth movement
  • digital orthodontics

Published Papers (15 papers)

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Research

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13 pages, 833 KiB  
Article
A Three-Dimensional Evaluation of Skeletal and Dentoalveolar Changes in Growing Class II Patients after Functional Appliance Therapy: A Retrospective Case-Control Study
by Paolo M. Cattaneo, Annemarie Holm, Augustine K. C. Yung, Stig Isidor and Marie A. Cornelis
J. Clin. Med. 2024, 13(5), 1315; https://doi.org/10.3390/jcm13051315 - 26 Feb 2024
Viewed by 777
Abstract
Background: The aim was to assess three-dimensionally mandibular and maxillary changes in growing Class II patients treated with removable functional appliances followed by fixed appliances. Methods: Twenty-four Class II patients (age range: 9 to 14, mean: 12.1 ± 1.1 years) treated with [...] Read more.
Background: The aim was to assess three-dimensionally mandibular and maxillary changes in growing Class II patients treated with removable functional appliances followed by fixed appliances. Methods: Twenty-four Class II patients (age range: 9 to 14, mean: 12.1 ± 1.1 years) treated with removable functional appliances followed by fixed appliances (functional appliance group—FAG) were retrospectively selected and compared to an age-matched control group (CG) treated with fixed appliances only. To be included in the study, pre- and post-treatment CBCT scans had to be available. The CBCTs were used to analyze, in 3D, the changes following treatment and growth. Results: Before treatment, overjet (FAG: 9 mm ± 2.8 (mean ± standard deviation); CG: 4 mm ± 1.7), ANB (FAG: 5.7° ± 2.0; CG: 3.2° ± 1.4), and effective mandibular length (FAG: 113.0 mm ± 4.1; CG: 116.6 mm ± 5.9) were statistically significantly different between the two groups. After treatment, overjet (FAG: −6.8 mm ± 2.8; CG: −1.8 mm ± 1.8) and effective mandibular length (FAG: 6.3 mm ± 2.6; CG: 3.9 mm ± 2.6) statistically significantly changed. There was a significant difference in the treatment effect between the FAG and the CG in overjet, ANB, and effective mandibular length. Conclusions: The results indicate that functional appliances are effective in correcting Class II malocclusions. The growth modification in the FAG resulted in an increase in mandibular length. Yet, the final length of the mandible in the FAG was smaller when compared to the CG. Full article
(This article belongs to the Special Issue Orthodontics: Current Clinical Status and Future Challenges)
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12 pages, 1366 KiB  
Article
Striving for Perfection: How Stable Is Orthodontic Treatment When Excellent Outcomes Are Achieved? A 9-Year Post-Treatment Retrospective Study
by Marie A. Cornelis, Arwa Gera, Shadi Gera, Alona Isenshtat and Paolo M. Cattaneo
J. Clin. Med. 2023, 12(24), 7692; https://doi.org/10.3390/jcm12247692 - 14 Dec 2023
Viewed by 824
Abstract
(1) Aims: The main objective of this retrospective study was to assess the long-term stability of difficult orthodontic treatments treated to an excellent result and to correlate stability to possible prognostic factors. Secondary objectives were to observe the changes in retention protocol over [...] Read more.
(1) Aims: The main objective of this retrospective study was to assess the long-term stability of difficult orthodontic treatments treated to an excellent result and to correlate stability to possible prognostic factors. Secondary objectives were to observe the changes in retention protocol over time and to assess Oral Health-related Quality of Life (OHRQoL) after a long-term post-treatment follow-up. (2) Methods: Cases presented for final examination by orthodontic postgraduate students were retrospectively screened for eligibility. Eligible patients were recalled for a post-treatment recall appointment (T2), consisting of a clinical examination and intraoral scan, and were asked to complete the Oral Health Impact Profile-14 (OHIP-14-DK). Gender, age at treatment commencement (T0), treatment modality and duration, and retention protocol were extracted from the records. At T2, the duration of the retention period was recorded, and retainers in place were clinically compared to the original retention protocol. The following variables were assessed on the sets of models at T0, T1 (end of treatment), and T2: arch length and width, overjet and overbite, Dental Aesthetic Index (DAI), Peer Assessment Rating score (PAR), and Little’s Irregularity Index (LII). Multiple regression models were conducted. (3) Results: Eighty-five subjects attended T2. The mean post-treatment follow-up was 9.4 years +/− 2.4. In the upper arch, at T1, 74 patients had a combination of fixed and removable retainers, while at T2, 55 had a fixed retainer only. In the lower arch, at T1, 67 patients had a fixed retainer only, with this number increasing to 76 at T2. From T0 to T1, the PAR score improved by 96.1%, with the improvement remaining at 77.5% at T2. The stability of lower inter-canine and upper inter-premolar widths was significantly correlated with the extent of changes during treatment. The presence of a lower fixed retainer at T2 and a low LII at T1 were prognostic factors for stability. The mean weighted total OHIP-14 score at T2 was very low (1.6 ± 2.4 points). (4) Conclusions: In a sample with an initial high-severity malocclusion and treated to an excellent outcome, long-term stability was very good. Good stability can be retained when a lower fixed retainer is present at T2 and when a low LII is achieved at T1. Full article
(This article belongs to the Special Issue Orthodontics: Current Clinical Status and Future Challenges)
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12 pages, 1068 KiB  
Article
Male and Female Discrepancies in Anxiety, Depressive Symptoms, and Coping Strategies among Orthognathic Patients: A Cross-Sectional Analysis
by Robert Avramut, Serban Talpos, Camelia Szuhanek, Marius Pricop, Roxana Talpos, Tareq Hajaj, Nicoleta Nikolajevic-Stoican, Raluca Maracineanu, Roxana Ghircau-Radu and Malina Popa
J. Clin. Med. 2023, 12(22), 7161; https://doi.org/10.3390/jcm12227161 - 18 Nov 2023
Viewed by 825
Abstract
With an increasing understanding of the differences between men and women’s psychological experiences, this study aimed to probe the sex-based differences in anxiety, depressive symptoms, and coping strategies among orthognathic patients. The study hypothesis was that female patients would show higher levels of [...] Read more.
With an increasing understanding of the differences between men and women’s psychological experiences, this study aimed to probe the sex-based differences in anxiety, depressive symptoms, and coping strategies among orthognathic patients. The study hypothesis was that female patients would show higher levels of anxiety and depressive symptoms than males, and that coping mechanisms would differ between male and female sexes. A cross-sectional design was adopted, examining orthognathic patients from the Department of Oral and Maxillo-Facial Surgery at the Emergency Clinical Municipal Hospital in Timisoara, Romania, from 2020 to 2023. Eligible participants (18+ years with no prior orthognathic treatment) completed a comprehensive online questionnaire 6 weeks before scheduled surgery. This was composed of validated self-report instruments comprising the SF-36, GAD-7, and the PHQ-9, and the COPE-60, along with additional sociodemographic data. Of the 127 orthognathic patients analyzed (68 men and 59 women, aged 18 to 65 years, mean age 32), men rated their physical health status slightly better on the SF-36 scale. However, the most notable difference was in mental health, with females scoring higher on both the PHQ-9 (indicative of depression) and the GAD-7 (indicative of anxiety) scales. Specifically, female participants exhibited average PHQ-9 scores 1.8 points higher and GAD-7 scores 1.5 points higher than their male counterparts. Coping mechanisms also varied: 42% of male patients primarily employed “Disengagement” strategies, while 58% of females predominantly used “Engagement” and “Emotion Focused” strategies. Emotion-focused coping was associated with a 1.6-fold increased risk of depressive symptoms. Sex differences play a crucial role in the psychological experiences of orthognathic patients, evident in anxiety and depression levels, perceived health status, and coping strategies. This underlines the importance of sex-tailored psychological support in the preoperative phase for orthognathic surgery patients. Full article
(This article belongs to the Special Issue Orthodontics: Current Clinical Status and Future Challenges)
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12 pages, 1612 KiB  
Article
Long-Term Assessment of Treatment Timing for Rapid Maxillary Expansion and Facemask Therapy Followed by Fixed Appliances: A Multicenter Retro-Prospective Study
by Valentina Rutili, Bernardo Quiroga Souki, Michele Nieri, Ana Luiza Farnese Morais Carlos, Chiara Pavoni, Paola Cozza, James A. McNamara, Jr., Veronica Giuntini and Lorenzo Franchi
J. Clin. Med. 2023, 12(21), 6930; https://doi.org/10.3390/jcm12216930 - 05 Nov 2023
Cited by 1 | Viewed by 907
Abstract
Background: to determine the role of treatment timing in the long-term effects produced by rapid maxillary expansion and facemask therapy (RME/FM) in Class III patients. Methods: This study compared two sample groups treated with RME/FM followed by fixed appliances: the early prepubertal group [...] Read more.
Background: to determine the role of treatment timing in the long-term effects produced by rapid maxillary expansion and facemask therapy (RME/FM) in Class III patients. Methods: This study compared two sample groups treated with RME/FM followed by fixed appliances: the early prepubertal group (EPG) (17 patients; mean age before treatment (T0), 5.8 ± 0.7 years; range, 4.3–6.9 years) and the late prepubertal group (LPG) (17 patients; mean age at T0, 10.1 ± 0.8 years; range, 9.0–11.1 years). Lateral cephalograms for the two groups were examined before treatment (T0) and at a long-term observation (T1) (EPG, 19.8 ± 1.0 years; LPG, 21.0 ± 2.1 years). Independent sample t-tests were performed to compare the two groups at T0 and T1. Results: No statistically significant differences were found for any of the cephalometric variables at T0, except for the total mandibular length, overjet, and inclination of the maxillary incisors to the palatal plane, which were greater in the LPG. At T1, no statistically significant differences were detected for any of the cephalometric variables. Conclusions: There were no significant long-term differences when treating Class III patients with RME/FM, either during an early prepubertal phase (≤7 years of age) or during a late prepubertal phase (≥9 years of age). Full article
(This article belongs to the Special Issue Orthodontics: Current Clinical Status and Future Challenges)
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10 pages, 1792 KiB  
Article
Erosive Tooth Wear in Subjects with Normal Occlusion: A Pioneering Longitudinal Study up to the Age of 60
by Henrique Campos Eto, Felicia Miranda, Daniela Rios, Heitor Marques Honório, Guilherme Janson, Camila Massaro and Daniela Garib
J. Clin. Med. 2023, 12(19), 6318; https://doi.org/10.3390/jcm12196318 - 30 Sep 2023
Viewed by 762
Abstract
The aim of this study was to assess the erosive tooth wear (ETW) at early and mature adulthood in subjects with natural normal occlusion. The sample consisted of 23 untreated subjects with normal occlusion. Dental models were taken longitudinally from the same subjects [...] Read more.
The aim of this study was to assess the erosive tooth wear (ETW) at early and mature adulthood in subjects with natural normal occlusion. The sample consisted of 23 untreated subjects with normal occlusion. Dental models were taken longitudinally from the same subjects at 13 (T0), 17 (T1) and 60.9 years of age (T2) at a university. Evaluation of ETW was performed using a modified Basic Erosive Wear Examination (BEWE) index. Interphase changes were evaluated using Friedman and Dunn’s test. Ordinal logistic regression was used to assess the influence of sex, dental arch, tooth and dental surfaces on the erosive tooth wear. Linear regression was used to evaluate whether the ETW degree at T1 could discriminate the degree of ETW at T2. The significance level adopted was 5%. ETW showed a significant increase with aging. The median ETW index at T0, T1 and T2 was 2, 4 and 7, respectively. ETW was greater in males in the incisors and canines and on the incisal/occlusal and lingual tooth surfaces. No significant differences were found between the maxillary and mandibular arches. Subjects with severe ETW at mature adulthood had greater tooth wear at age 17. In conclusion, ETW significantly increased during aging in subjects with normal occlusion. The greater the degree of tooth wear at early adulthood, the greater the tooth wear at mature adulthood. Preventive care should be recommended during early adulthood in patients demonstrating erosive tooth wear in order to avoid worsening with aging. Full article
(This article belongs to the Special Issue Orthodontics: Current Clinical Status and Future Challenges)
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10 pages, 244 KiB  
Article
A Cross-Sectional Study of Factors Influencing Pre-Operative Anxiety in Orthognathic Patients
by Xiu Ling Florence Kok, Jamie Gwilliam, Mark Sayers, Elinor M. Jones and Susan J. Cunningham
J. Clin. Med. 2023, 12(16), 5305; https://doi.org/10.3390/jcm12165305 - 15 Aug 2023
Cited by 1 | Viewed by 775
Abstract
Orthognathic treatment is an important treatment modality to manage severe dentofacial discrepancies. Patients awaiting orthognathic surgery often experience increased anxiety, which may adversely affect post-operative recovery and treatment satisfaction. This study investigated the effects of a number of factors on pre-operative anxiety in [...] Read more.
Orthognathic treatment is an important treatment modality to manage severe dentofacial discrepancies. Patients awaiting orthognathic surgery often experience increased anxiety, which may adversely affect post-operative recovery and treatment satisfaction. This study investigated the effects of a number of factors on pre-operative anxiety in orthognathic patients. Seventy patients prospectively recruited from three orthognathic centres in the UK completed a pre-operative questionnaire that included validated scales for measuring anxiety, social support, resilience, and coping styles. Sociodemographic data and satisfaction with the information provided by the clinical team were also elicited from the questionnaire. Univariable analysis showed that social support from a significant other (p = 0.026), resilience (p < 0.001), and satisfaction with the information provided by the clinical team (p = 0.002) were significantly associated with reduced anxiety, whilst avoidance coping (p < 0.001) and coping through seeking social support (p = 0.006) were significantly related to increased anxiety. With the exception of coping by seeking social support, these relationships retained significance in a multivariable regression analysis. Neither gender nor ethnicity moderated the effects of social support on pre-operative anxiety. These findings suggest potential avenues for clinicians to address with future interventions to reduce pre-operative anxiety. Further qualitative research may provide greater clarity on the relationship between these variables and anxiety. Full article
(This article belongs to the Special Issue Orthodontics: Current Clinical Status and Future Challenges)
23 pages, 1045 KiB  
Article
Relation between Maximum Oral Muscle Pressure and Dentoalveolar Characteristics in Patients with Cleft Lip and/or Palate: A Prospective Comparative Study
by Lisa Van Geneugden, Anna Verdonck, Guy Willems, Greet Hens and Maria Cadenas de Llano-Pérula
J. Clin. Med. 2023, 12(14), 4598; https://doi.org/10.3390/jcm12144598 - 10 Jul 2023
Viewed by 826
Abstract
Background: Perioral muscle function, which influences maxillofacial growth and tooth position, can be affected in patients with oral clefts due to their inherent anatomical characteristics and the multiple surgical corrections performed. This research aims to (1) compare the maximum oral muscle pressure of [...] Read more.
Background: Perioral muscle function, which influences maxillofacial growth and tooth position, can be affected in patients with oral clefts due to their inherent anatomical characteristics and the multiple surgical corrections performed. This research aims to (1) compare the maximum oral muscle pressure of subjects with and without isolated cleft palate (CP) or unilateral cleft lip and palate (UCLP), (2) investigate its influence on their dentoalveolar characteristics, and (3) investigate the influence of functional habits on the maximum oral muscle pressure in patients with and without cleft. Material and methods: Subjects with and without CP and UCLP seeking treatment at the Department of Orthodontics of University Hospitals Leuven between January 2021 and August 2022 were invited to participate. The Iowa Oral Performance Instrument (IOPI) was used to measure their maximum tongue, lip, and cheek pressure. An imbalance score was calculated to express the relationship between tongue and lip pressure. Upper and lower intercanine (ICD) and intermolar distance (IMD) were measured on 3D digital dental casts, and the presence of functional habits was reported by the patients. The data were analyzed with multivariable linear models, correcting for age and gender. Results: 44 subjects with CP or UCLP (mean age: 12.00 years) and 104 non-affected patients (mean age: 11.13 years) were included. No significant differences in maximum oral muscle pressure or imbalance score were detected between controls and clefts or between cleft types. Significantly smaller upper ICDs and larger upper and lower IMDs were found in patients with clefts. A significant difference between controls and clefts was found in the relationship between oral muscle pressure and transversal jaw width. In cleft patients, the higher the maximum tongue pressure, the wider the upper and lower IMD, the higher the lip pressure, the smaller the upper and lower ICD and IMD, and the higher the imbalance score, the larger the upper and lower IMD and lower ICD. An imbalance favoring the tongue was found in cleft patients. The influence of functional habits on the maximum oral muscle pressure was not statistically different between clefts and controls. Conclusion: Patients with CP or UCLP did not present reduced maximum oral muscle pressure compared with patients without a cleft. In cleft patients, tongue pressure was consistently greater than lip pressure, and those who presented a larger maxillary width presented systematically higher imbalance scores (favoring the tongue) than those with narrow maxillae. Therefore, the influence of slow maxillary expansion on maximum oral muscle pressure in cleft patients should not be underestimated. Full article
(This article belongs to the Special Issue Orthodontics: Current Clinical Status and Future Challenges)
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13 pages, 5525 KiB  
Article
Eruption Pattern of Third Molars in Orthodontic Patients Treated with First Permanent Molar Extraction: A Longitudinal Retrospective Evaluation
by Lisa J. Langer, Nikolaos Pandis, Maria R. Mang de la Rosa, Paul-Georg Jost-Brinkmann and Theodosia N. Bartzela
J. Clin. Med. 2023, 12(3), 1060; https://doi.org/10.3390/jcm12031060 - 30 Jan 2023
Cited by 3 | Viewed by 2025
Abstract
The aim of this study was to evaluate angular and positional changes in the second (M2) and third molars (M3) of orthodontically treated patients undergoing a first molar (M1) extraction. A retrospective longitudinal study with a sample of 152 pre- and post-treatment panoramic [...] Read more.
The aim of this study was to evaluate angular and positional changes in the second (M2) and third molars (M3) of orthodontically treated patients undergoing a first molar (M1) extraction. A retrospective longitudinal study with a sample of 152 pre- and post-treatment panoramic radiographs was conducted. Thirty-nine patients (51.3%) were orthodontically treated with M1 extraction and thirty-seven (48.7%) were treated without extraction. Angulations of M2 and M3 relative to the infraorbital (IOP) and the palatal planes (PP) were measured and compared between the groups before orthodontic treatment (T1) and after the completion of orthodontic space closure (T2). The prognosis of M3 eruptions was evaluated by assessing their horizontal and vertical position (inclination) using different classification systems. The angular (p < 0.001) and inclination improvement (p < 0.01) of the maxillary M3 was significant for the M1 extraction group. The mandibular M3 inclination significantly improved (p < 0.01), whereas the groups’ angulation and vertical position were not significantly different. These findings suggest that extraction therapy has a favorable effect on the maxillary M2 and M3 angulation, but not on the mandibular. M1 extraction showed a signi- ficant effect on the horizontal position of M3 and thus may improve the eruption space and prognosis. Full article
(This article belongs to the Special Issue Orthodontics: Current Clinical Status and Future Challenges)
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14 pages, 3453 KiB  
Article
Automatic Masseter Muscle Accurate Segmentation from CBCT Using Deep Learning-Based Model
by Yiran Jiang, Fangxin Shang, Jiale Peng, Jie Liang, Yi Fan, Zhongpeng Yang, Yuhan Qi, Yehui Yang, Tianmin Xu and Ruoping Jiang
J. Clin. Med. 2023, 12(1), 55; https://doi.org/10.3390/jcm12010055 - 21 Dec 2022
Cited by 2 | Viewed by 1443
Abstract
Segmentation of the masseter muscle (MM) on cone-beam computed tomography (CBCT) is challenging due to the lack of sufficient soft-tissue contrast. Moreover, manual segmentation is laborious and time-consuming. The purpose of this study was to propose a deep learning-based automatic approach to accurately [...] Read more.
Segmentation of the masseter muscle (MM) on cone-beam computed tomography (CBCT) is challenging due to the lack of sufficient soft-tissue contrast. Moreover, manual segmentation is laborious and time-consuming. The purpose of this study was to propose a deep learning-based automatic approach to accurately segment the MM from CBCT under the refinement of high-quality paired computed tomography (CT). Fifty independent CBCT and 42 clinically hard-to-obtain paired CBCT and CT were manually annotated by two observers. A 3D U-shape network was carefully designed to segment the MM effectively. Manual annotations on CT were set as the ground truth. Additionally, an extra five CT and five CBCT auto-segmentation results were revised by one oral and maxillofacial anatomy expert to evaluate their clinical suitability. CBCT auto-segmentation results were comparable to the CT counterparts and significantly improved the similarity with the ground truth compared with manual annotations on CBCT. The automatic approach was more than 332 times shorter than that of a human operation. Only 0.52% of the manual revision fraction was required. This automatic model could simultaneously and accurately segment the MM structures on CBCT and CT, which can improve clinical efficiency and efficacy, and provide critical information for personalized treatment and long-term follow-up. Full article
(This article belongs to the Special Issue Orthodontics: Current Clinical Status and Future Challenges)
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12 pages, 1355 KiB  
Article
The Prediction Accuracy of Digital Orthodontic Setups for the Orthodontic Phase before Orthognathic Surgery
by Olivier de Waard, Frank Baan, Robin Bruggink, Ewald M. Bronkhorst, Anne Marie Kuijpers-Jagtman and Edwin M. Ongkosuwito
J. Clin. Med. 2022, 11(20), 6141; https://doi.org/10.3390/jcm11206141 - 18 Oct 2022
Cited by 5 | Viewed by 1570
Abstract
The purpose of this study was to verify whether pre-treatment digital setups can accurately predict the tooth positions after presurgical orthodontic treatment has been performed in a 3-dimensional way. Twenty-six patients who underwent a combined orthodontic-orthognathic surgical treatment were included. Pre-treatment digital dental [...] Read more.
The purpose of this study was to verify whether pre-treatment digital setups can accurately predict the tooth positions after presurgical orthodontic treatment has been performed in a 3-dimensional way. Twenty-six patients who underwent a combined orthodontic-orthognathic surgical treatment were included. Pre-treatment digital dental models were merged with cone beam computed tomography (CBCT) scans. One operator fabricated virtual setups to simulate the tooth movements of the presurgical orthodontic treatment. Prior to surgery, digital dental models were merged with the CBCT scans. Differences between de virtual setups and the presurgical dental models were calculated using linear mixed model analyses. Differences in tooth displacements exceeding the boundaries of clinical acceptance (>2 degrees for rotations and >0.6 mm for translations) were found in 75% of the rotational and 52% of translational mean differences in the maxilla and in 74% of the rotational mean differences and 44% of the translational mean differences in the mandible. Significant differences were found for all tooth types and in all tooth displacement directions with significant effects of extractions and surgically assisted rapid maxillary expansion (SARME) procedures. The accuracy of the digital setup is still too limited to correctly simulate the presurgical orthodontic treatment. Full article
(This article belongs to the Special Issue Orthodontics: Current Clinical Status and Future Challenges)
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11 pages, 3176 KiB  
Article
CBCT Analysis of Dento-Skeletal Changes after Rapid versus Slow Maxillary Expansion on Deciduous Teeth: A Randomized Clinical Trial
by Marco Serafin, Rosamaria Fastuca and Alberto Caprioglio
J. Clin. Med. 2022, 11(16), 4887; https://doi.org/10.3390/jcm11164887 - 20 Aug 2022
Cited by 5 | Viewed by 2121
Abstract
The aim of the present study was to compare skeletal and dental changes after rapid maxillary expansion (RME) and slow maxillary expansion (SME) performed by a Leaf Expander (LE) with upper deciduous teeth as anchorage and using 3D CBCT (Cone Beam Computed Tomography) [...] Read more.
The aim of the present study was to compare skeletal and dental changes after rapid maxillary expansion (RME) and slow maxillary expansion (SME) performed by a Leaf Expander (LE) with upper deciduous teeth as anchorage and using 3D CBCT (Cone Beam Computed Tomography) analysis. Mixed dentition patients were randomly divided in two groups, according to the different expansion used anchored on maxillary primary second molars: the RME group (n = 16) was treated with a Hyrax type expander, whereas the SME group (n = 16) was treated with an LE expander. CBCT scans were performed before (T1) and after treatment (T2) and analyzed with a custom landmarks system. A paired t-test was used for intragroup analysis between T1 and T2, and a Student t-test was used for intergroup analysis; statistical significance was set at 0.05. Both RME and SME groups showed a statistically significant increase in dental and skeletal diameters. Group comparisons between T1 and T2 showed a significant expansion rate in the RME group for upper permanent molars (p = 0.025) but not for deciduous molars (p = 0.790). Moreover, RME showed higher increases for skeletal expansion evaluated at nasal walls (p = 0.041), whereas at pterygoid plates did not show any significant differences compared with the SME group (p = 0.849). A significant transverse expansion could be achieved with the expander anchored on deciduous teeth. RME and SME produced effective both skeletal and dentoalveolar transverse expansion; RME produced more anterior expansion than SME but less control regarding the permanent molar decompensation. SME by LE therefore could be an efficient and helpful alternative in the treatment of transverse maxillary deficiency in growing patients. Full article
(This article belongs to the Special Issue Orthodontics: Current Clinical Status and Future Challenges)
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11 pages, 506 KiB  
Article
Skeletal, Dental and Soft Tissue Cephalometric Changes after Orthodontic Treatment of Dental Class II Malocclusion with Maxillary First Molar or First Premolar Extractions
by Johan Willem Booij, Marco Serafin, Rosamaria Fastuca, Anne Marie Kuijpers-Jagtman and Alberto Caprioglio
J. Clin. Med. 2022, 11(11), 3170; https://doi.org/10.3390/jcm11113170 - 02 Jun 2022
Cited by 4 | Viewed by 2330
Abstract
The aim of the present retrospective study was evaluating skeletal, dental and soft tissue changes of two groups of Class II patients orthodontically treated with extractions of upper first premolars (U4 group) and upper first molars (U6 group). In total, 21 patient records [...] Read more.
The aim of the present retrospective study was evaluating skeletal, dental and soft tissue changes of two groups of Class II patients orthodontically treated with extractions of upper first premolars (U4 group) and upper first molars (U6 group). In total, 21 patient records (9M and 12F; mean age 12.5 ± 1.2 years) were selected for the U4 group, and 38 patient records (17M and 21F; mean age 13.2 ± 1.3 years) were recruited for the U6 group. Twenty cephalometric variables were analysed on standardised lateral cephalograms at baseline (T0) and at the end of orthodontic treatment (T1). Means and standard deviations (SDs) were calculated for both groups and increments were calculated. After revealing the normal distribution of data with the Shapiro–Wilk test, Student’s t-test was used to compare variables at T0 between groups. A paired t-test was used to analyse changes between time points within each group, and Student’s t-test to compare differences between groups at T1. Both groups showed a significant increase in the distance among upper second molars and the vertical pterygoid line (PTV-maxillary second molar centroid U6 group: 6.66 ± 5.00 mm; U4 group: 3.66 ± 2.20 mm). Moreover, the distance of upper incisors to the palatal plane significantly increased (PP-maxillary incisor tip U6 group: 1.09 ± 1.52 mm; U4 group: 0.20 ± 2.00 mm; p = 0.061). Significant changes were found for overjet (U6 group: −4.86 ± 1.62 mm; U4 group: −3.27 ± 1.90 mm; p = 0.001). The distance between upper lip and esthetic plane showed a significantly reduction in both groups (ULip-E Plane U6 group: −2.98 ± 1.65 mm; U4 group: −1.93 ± 1.57 mm). No statistically significant changes were found in sagittal or vertical skeletal values. The significantly larger reduction of upper lip protrusion and overjet in the U6 group compared to the U4 group suggests preferring molar extraction treatment for severe Class II with protrusive soft tissues’ profile and increased overjet. Since no differences on vertical values were found, an increased SN^GoGn angle should not be considered a discriminating factor for choosing molar extraction treatment. Full article
(This article belongs to the Special Issue Orthodontics: Current Clinical Status and Future Challenges)
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Review

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21 pages, 4060 KiB  
Review
Evidence Mapping and Quality Analysis of Systematic Reviews on Various Aspects Related to Cleft Lip and Palate
by Sukeshana Srivastav, Nitesh Tewari, Gregory S. Antonarakis, Ritu Duggal, Seba Saji, Amol Kumar Lokade and Rahul Yadav
J. Clin. Med. 2023, 12(18), 6002; https://doi.org/10.3390/jcm12186002 - 16 Sep 2023
Viewed by 898
Abstract
Background: Management of cleft lip and palate is interdisciplinary. An evidence-mapping approach was envisaged to highlight the existing gaps in this field, using only the highest level of evidence. Objectives: To conduct evidence mapping and quality analysis of systematic reviews and meta-analyses related [...] Read more.
Background: Management of cleft lip and palate is interdisciplinary. An evidence-mapping approach was envisaged to highlight the existing gaps in this field, using only the highest level of evidence. Objectives: To conduct evidence mapping and quality analysis of systematic reviews and meta-analyses related to any aspect of cleft lip and palate. Search Methods: The cleft lip and palate field was divided into 9 domains and 50 subdomains and a method of categorization of systematic reviews was established. A comprehensive search strategy was carried out in seven databases along with the search of gray literature and references of included articles. Selection criteria: Systematic reviews related to any aspect of cleft lip and palate, conducted by a minimum of two reviewers, with a comprehensive search strategy and adequate quality analysis were included. Data collection and analysis: A self-designed, pre-piloted data-extraction sheet was used to collect information that was analyzed through an expert group discussion. Quality analysis was performed using ROBIS-I, AMSTAR 2, and the PRISMA checklist. Results: A total of 144 systematic reviews published between 2008 and 2022 were included. The largest number of these could be categorized in the therapeutic domain (n = 58). A total of 27% of the studies were categorized as inconclusive, 40% as partially conclusive, and 33% as conclusive. As per ROBIS-I, 77% of reviews had high risk of bias while 58% were graded as critically low in quality as per AMSTAR 2. The majority of systematic reviews showed low reporting errors. Conclusions: The majority of systematic reviews related to cleft lip and palate relate to therapeutic and prognostic domains and show high risk of bias and critically low quality regardless of the source journal. The results of this paper might serve as a starting point encouraging authors to carry out high-quality research where evidence is lacking. Registration: A multidisciplinary expert-group formulated an a priori protocol, registered in Open Science Framework (DOI 10.17605/OSF.IO/NQDV2). Full article
(This article belongs to the Special Issue Orthodontics: Current Clinical Status and Future Challenges)
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Other

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19 pages, 2823 KiB  
Systematic Review
How Effective Are Non-Frictional Techniques Compared to Sliding Techniques in the Retraction of Upper Anterior Teeth When Using Buccal Fixed-Appliance Therapy? A Systematic Review
by Mohammad Naem Kheshfeh, Mohammad Younis Hajeer, Mhd. Firas Al Hinnawi, Mohammed Adel Awawdeh, Ali S. Aljhani and Nora Alhazmi
J. Clin. Med. 2023, 12(21), 6757; https://doi.org/10.3390/jcm12216757 - 25 Oct 2023
Viewed by 961
Abstract
Methods for retracting the anterior teeth are divided into frictional methods and non-frictional methods. However, evidence regarding the superiority of one technique over the other is still lacking in the available literature. Therefore, we aimed to evaluate the current evidence regarding the effectiveness [...] Read more.
Methods for retracting the anterior teeth are divided into frictional methods and non-frictional methods. However, evidence regarding the superiority of one technique over the other is still lacking in the available literature. Therefore, we aimed to evaluate the current evidence regarding the effectiveness of frictional methods of anterior teeth retraction compared to the non-frictional ones. The extracted data included the mechanism of application of the retraction force and its intensity, the observation period, follow-up records, and outcome measures. Ten studies were included in this review; the results did not favor a specific technique regarding the rate of orthodontic tooth movement and loss of anchorage during canine retraction, although a preference was shown for the sliding technique in the rate of en-masse retraction (0.74 versus 0.39 mm/month) and the anchorage control during the retraction of the incisors (0.5 versus 0.1 mm/month). The control of the incisor’s torque during the en-masse retraction was higher when frictionless techniques were used (−12° versus −7°). Regarding the rate of orthodontic tooth movement, the non-frictional technique is characterized by a high sensitivity to the quality of the design, and the sliding technique was generally effective. As for controlling the torque of the incisors, the preference is for the non-frictional technique. Overall, there is a need to conduct more studies with an appropriate design. Full article
(This article belongs to the Special Issue Orthodontics: Current Clinical Status and Future Challenges)
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Graphical abstract

12 pages, 1576 KiB  
Systematic Review
Craniofacial Cephalometric Characteristics and Open Bite Deformity in Individuals with Amelogenesis Imperfecta—A Systematic Review and Meta-Analysis
by Yassine Messaoudi, Stavros Kiliaridis and Gregory S. Antonarakis
J. Clin. Med. 2023, 12(11), 3826; https://doi.org/10.3390/jcm12113826 - 02 Jun 2023
Cited by 1 | Viewed by 1054
Abstract
Background: Individuals with amelogenesis imperfecta (AI) often present with malocclusions, especially a dental or skeletal anterior open bite (AOB). Objectives: To evaluate the craniofacial characteristics in individuals with AI. Material and methods: A systematic literature search was conducted with the PubMed, Web of [...] Read more.
Background: Individuals with amelogenesis imperfecta (AI) often present with malocclusions, especially a dental or skeletal anterior open bite (AOB). Objectives: To evaluate the craniofacial characteristics in individuals with AI. Material and methods: A systematic literature search was conducted with the PubMed, Web of Science, Embase and Google Scholar databases to identify studies relating to the cephalometric characteristics of individuals with AI, without any language or publication date restrictions. The grey literature was searched using Google Scholar, Opengrey and Worldcat. Only studies with a suitable control group for comparison were included. Data extraction and a risk of bias assessment were carried out. A meta-analysis was performed using the random effects model for cephalometric variables that were evaluated in at least three studies. Results: The initial literature search yielded 1857 articles. Following the removal of duplicates and a screening of the records, seven articles were included in the qualitative synthesis, representing a total of 242 individuals with AI. Four studies were included in the quantitative synthesis. The meta-analysis results showed that individuals with AI present a smaller SNB angle and larger ANB angle than those of control groups in the sagittal plane. In the vertical plane, those with AI present a smaller overbite and larger intermaxillary angle than those without AI. No statistically significant differences were found for the SNA angle when comparing the two groups. Conclusions: Individuals with AI seem to present with more vertical craniofacial growth, leading to an increased intermaxillary angle and decreased overbite. This possibly leads to a more retrognathic mandible with a larger ANB angle due to an anticipated posterior mandibular rotation. Full article
(This article belongs to the Special Issue Orthodontics: Current Clinical Status and Future Challenges)
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