Search Results (172)

Unlike skeletal Class I and II patients, the application of maxillomandibular advancement (MMA) in skeletal Class III patients with obstructive sleep apnea (OSA) is not well documented. The aim of this scoping review was to explore the variations and outcomes of MMA techniques in this unique subgroup. A comprehensive search of PubMed, Embase, Cochrane and LILACS databases were conducted for articles published up to May 2025. Nine studies met the inclusion criteria. Three main variations of MMA were identified: (1) Bimaxillary advancement, which provides the most significant airway enlargement across all pharyngeal regions but carries the highest risk of facial aesthetic distortion; (2) Maxillary advancement with mandibular auto-rotation, a less invasive option suited for patients with isolated maxillary retrusion and symmetrical mandibular anatomy; (3) Maxillary advancement with mandibular setback, which addresses aesthetic concerns in patients with mandibular excess but may compromise oropharyngeal airway space. All variations were reported to be effective in treating OSA (Reduction of AHI by at least 50%) but with different considerations. Surgical planning for skeletal Class III patients with OSA should be individualized based on craniofacial morphology, anatomical site of airway obstruction, and aesthetic considerations. A decision flowchart was shared in this study. Full article

Background/Objectives: Accurate identification of dental malocclusions from routine clinical photographs can be time-consuming and subject to interobserver variability. A YOLOv11-based deep learning approach is presented and evaluated for automatic malocclusion detection on routine intraoral photographs, testing the hypothesis that training on a structured annotation protocol enables reliable detection of multiple clinically relevant malocclusions. Methods: An anonymized dataset of 5854 intraoral photographs (frontal occlusion; right/left buccal; maxillary/mandibular occlusal) was labeled according to standardized instructions derived from the Index of Orthodontic Treatment Need (IOTN) A total of 17 clinically relevant classes were annotated with bounding boxes. Due to an insufficient number of examples, two malocclusions (transposition and non-occlusion) were excluded from our quantitative analysis. A YOLOv11 model was trained with augmented data and evaluated on a held-out test set using mean average precision at IoU 0.5 (mAP50), macro precision (macro-P), and macro recall (macro-R). Results: Across 15 analyzed classes, the model achieved 87.8% mAP50, 76.9% macro-P, and 86.1% macro-R. The highest per-class AP₅₀ was observed for Deep bite (98.8%), Diastema (97.9%), Angle Class II canine (97.5%), Anterior open bite (92.8%), Midline shift (91.8%), Angle Class II molar (91.1%), Spacing (91%), and Crowding (90.1%). Moderate performance included Anterior crossbite (88.3%), Angle Class III molar (87.4%), Head bite (82.7%), and Posterior open bite (80.2%). Lower values were seen for Angle Class III canine (76%), Posterior crossbite (75.6%), and Big overjet (75.3%). Precision–recall trends indicate earlier precision drop-off for posterior/transverse classes and comparatively more missed detections in Posterior crossbite, whereas Big overjet exhibited more false positives at the chosen threshold. Conclusion: A YOLOv11-based deep learning system can accurately detect several clinically salient malocclusions on routine intraoral photographs, supporting efficient screening and standardized documentation. Performance gaps align with limited examples and visualization constraints in posterior regions. Larger, multi-center datasets, protocol standardization, quantitative metrics, and multimodal inputs may further improve robustness. Full article

Background/Objectives: Geometric morphometric analysis (GMA) is a statistical method that captures and quantifies shape variation. This study aimed to assess hard and soft tissue shape variations and changes following orthodontic treatment in Class III skeletal malocclusion using GMA. Methods: A retrospective study was conducted on 84 lateral cephalometric radiographs (pre-treatment and near-end treatment) of Class III patients aged 16–40 years (ANB < 2°). Thirty-five landmarks were digitized in Cartesian coordinates using MorphoJ software for shape analysis. Results: The sample included 62% females and 38% males, with a mean age of 24.7 ± 5.2 years. Vertical dimension variations (hypodivergent to hyperdivergent) contributed most to shape changes PC1 (23.35%), followed by anteroposterior variations PC2 (13.51%). Gender significantly influenced hard and soft tissue variation with 30.91%SS (F = 56.99, p < 0.0001). Males had significantly larger and longer ramus, body of the mandible, alveolar height, LAFH, TAFH and upper lip length. (PD: 0.026, p < 0.05). Significant shape changes were seen in the mandible (PD = 0.018, p < 0.05). SNB increased by 0.41° (from 81.73° ± 3.67°), and ANB improved by 0.46° but remained Class III (−0.33° ± 1.82°). Lower anterior facial height increased by 1.78 mm (p < 0.05). The lower incisors retroclined significantly (from 92° ± 8.56° to 87° ± 6.96°, p < 0.05), while the interincisal angle increased by 5.9°. Upper incisors remained procline (118° ± 11°, p > 0.05). Upper lip length increased by 0.4 mm (p < 0.05). Conclusions: Vertical and anteroposterior shape variations are notable within Class III malocclusion. Post-treatment changes in both hard and soft tissues indicate that orthodontic camouflage can enhance facial esthetics and skeletal balance. GMA provides objective quantification and visualization of these treatment-related craniofacial changes. Full article

Background/Objectives: The aim of this study is to evaluate pretreatment osseous changes in the temporomandibular joint (TMJ) in orthognathic surgery patients using cone-beam computed tomography (CBCT) and to determine the distribution of the findings according to sagittal skeletal malocclusion groups. Methods: CBCT images of 103 patients (206 condyles) were retrospectively analyzed. Patients were classified as Class I, II, and III based on ANB angles. Condylar morphology was assessed for flattening, sclerosis, erosion, osteophyte formation, and subchondral bone cysts. All evaluations were performed by a single investigator (κ = 0.87). Group differences were analyzed using the chi-square test with Bonferroni correction (p < 0.05). Results: The most frequent alteration was flattening (29.6%), followed by sclerosis (11.2%), erosion (10.7%), osteophyte formation (8.3%), and subchondral bone cysts (4.4%). No significant sex-related differences were found (p > 0.05). A significant difference was observed only in sclerosis (p = 0.049), which was more prevalent in Class I than Class III. Flattening predominated in all groups, while erosion and osteophytes were more common in Class II, and sclerosis was more frequent in Class I. Conclusions: This study demonstrated that condylar flattening was the most common morphological alteration in orthognathic patients across all skeletal malocclusion groups. The higher prevalence of sclerosis in Class I compared with Class III suggests that mandibular positioning may influence adaptive and degenerative remodeling processes of the TMJ. This study emphasizes the importance of CBCT evaluation for detecting osseous changes in TMJ before orthognathic surgery and demonstrates that pre-existing alterations may impact surgical stability and postoperative functional outcomes. Full article

Mandibular prognathism (Class III malocclusion) is a craniofacial anomaly characterized by an anteriorly positioned mandible, a concave facial profile and impaired mastication, and appears unusually frequently in Dolang sheep (Ovis aries). We combined clinical phenotyping and three-dimensional (3D) genome profiling to investigate this trait in a Dolang sheep flock. We examined 959 animals using standardized criteria, estimated a local prevalence of 10.3%, and assembled a 200 affected/200 unaffected case–control cohort for genomic analyses. As an exploratory pilot study of 3D genome architecture, we generated in situ Hi-C datasets from mandibular bone of two affected and two control sheep. At 40 kb resolution, global topologically associating domain (TAD) organization and boundary strength were broadly conserved between groups, but sliding-window analyses identified a small number of 1 Mb hotspots where affected animals showed increased TAD-boundary density and strengthened insulation. These UNDER-enriched windows lay near genes with plausible roles in craniofacial development, including ROBO2, COL27A1, VRK2 and a cytokine cluster (IL22/IL26/IFNG with MDM1). Together, our data indicate that mandibular prognathism in Dolang sheep is associated with localized remodeling of chromatin insulation at a restricted set of gene-proximal loci and highlight candidate regions and mechanisms for integration with whole-genome sequencing, association and transcriptomic data. Full article

Introduction: Infantile Refsum disease (IRD) is considered one of the milder phenotypes within the Zellweger Spectrum Disorders (ZSDs), a group of peroxisomal biogenesis disorders characterized by a generalized impairment of peroxisomal function. Pathognomonic features of IRD are growth retardation, hearing and cognitive impairment, neuromuscular problems, and craniofacial anomalies. Due to the relatively short lifespan, severe dental anomalies have not been previously reported in association with this disorder. This case report describes a rare manifestation of multiple impacted teeth and near complete edentulism in an adult patient diagnosed with Infantile Refsum disease (IRD). Material and Methods: The patient, a 24-year-old female, presented with a skeletal Class III malocclusion, severe maxillary hypoplasia, and complete impaction of the permanent dentition. The diagnosis of Infantile Refsum disease (IRD) was genetically confirmed and was associated with both neurological and dermatological manifestations. Conclusions: This case underscores that severe disturbances in tooth eruption and impaction may represent underrecognized manifestations of metabolic and genetic disorders such as Infantile Refsum disease (IRD). Dental professionals should remain vigilant to the potential association between systemic conditions and delayed or failed tooth eruption, emphasizing the need for interdisciplinary management and further investigation. Full article

Background: This narrative review synthesizes evidence on AI for orthodontic malocclusion diagnosis across five imaging modalities and maps diagnostic metrics to validation tiers and regulatory readiness, with focused appraisal of Class III detection (2019–2025). Key algorithms, datasets, clinical validation, and ethical/regulatory considerations are synthesized. Methods: PubMed, Scopus, and Web of Science were searched for studies published January 2019–October 2025 using (“artificial intelligence”) AND (“malocclusion” OR “skeletal class”) AND “cephalometric.” Records were screened independently by two reviewers, with disagreements resolved by consensus. Eligible studies reported diagnostic performance (accuracy, area under the receiver operating characteristic curve (AUC), sensitivity/specificity) or landmark-localization error for AI-based malocclusion diagnosis. Data on dataset size and validation design were extracted; no formal quality appraisal or risk-of-bias assessments were undertaken, consistent with a narrative review. Results: Deep learning models show high diagnostic accuracy: cephalogram classifiers reach 90–96% for skeletal Class I/II/III; intraoral photograph models achieve 89–93% for Angle molar relationships; automated landmarkers localize ~75% of points within 2 mm. On 9870 multicenter cephalograms, landmarking achieved 0.94 ± 0.74 mm with ≈89% skeletal-class accuracy when landmarks fed a classifier. Conclusion: AI can reduce cephalometric tracing time by ~70–80% and provide consistent skeletal classification. Regulator-aligned benchmarks (multicenter external tests, subgroup reporting, explainability) and pragmatic open-data priorities are outlined, positioning AI as a dependable co-pilot once these gaps are closed. Full article

Background/Objectives: The relationship between occlusion and temporomandibular joint is controversial in the scientific literature. The aim of this study is to evaluate the bone changes in the temporomandibular joint and surrounding bone structures and to determine the effect of malocclusions on the temporomandibular joint by making morphometric measurements in different skeletal classes using three-dimensional cone beam computed tomography images. Methods: A total of 90 patients (30 class I, 30 class II and 30 class III) were included in the study. In each skeletal pattern, condylar osseous changes were evaluated and articular eminence inclination and height, condylar diameters were measured. It was also divided into two age groups: 18–29 and 30 and over. Results: Articular eminence inclination measured with the best-fit line method was significantly higher in Class II compared with class I and III, and in individuals aged ≥30 years. Among osseous changes, only condylar flattening showed a significant age-related increase. The mediolateral condylar diameter was greater in males than females, while the anteroposterior diameter was higher in the ≥30-year age group. Conclusions: Temporomandibular joint morphology demonstrates age- and function-related adaptive remodeling, particularly in articular eminence inclination and condylar dimensions. CBCT-based assessment of these morphological features may assist clinicians in diagnosis and treatment planning, although further studies with larger prospective cohorts are warranted. Full article

Background: The relationship between sagittal malocclusion, temporomandibular disorders (TMD), and musculoskeletal pain remains uncertain. Methods: Cross-sectional study (April 2020–August 2021) in Małopolska, Poland. Ninety participants (ages 19–35) were classified into Angle Classes I–III (n = 30 each) and examined using RDC/TMD (Axis I/II). A proprietary, nonvalidated, piloted whole-body pain-map questionnaire, presented in anterior and posterior views and subdividing the body into predefined craniofacial, spinal, and limb regions, was used to capture pain presence, Numerical Rating Scale (NRS, 0–10) scores by region, and the total number of painful sites. Group differences were analyzed using χ² and Kruskal–Wallis tests with corresponding effect sizes (measures of association strength). For NRS outcomes, a minimal clinically important difference (MCID)—defined as the smallest difference in NRS considered clinically relevant—was prespecified as approximately 1 point. Results: Occlusal class was not associated with TMD Axis I prevalence. However, sagittal malocclusion—particularly Class III—was linked to a less favorable pain profile. Left temporal pain was more frequent in Class III than in Classes I–II (p = 0.024, Cramér’s V = 0.31, medium effect), and cervical spine pain occurred more often in malocclusion groups than in Class I (p = 0.043, Cramér’s V = 0.26, small effect), indicating statistically significant associations. Cervical pain intensity was higher in Classes II–III than in Class I, with a pooled mean difference—defined as the difference in mean NRS between the combined Classes II–III and Class I—of 1.23 NRS points (95% CI 0.38–2.08), exceeding the ≈1-point MCID and suggesting a clinically important burden. The total number of painful sites was also greater in Class III than in Class I (p = 0.023, η² = 0.09; Δ = 1.40 sites, 95% CI 0.39–2.41), which indicates a statistically significant association with a medium effect size and a higher overall pain burden. Conclusions: Sagittal occlusal class was not associated with TMD diagnosis, but malocclusion—especially Class III—was associated with a more unfavorable craniofacial pain pattern and higher cervical pain burden (p ≤ 0.05), with effects of potential clinical relevance. Full article

Background: Supernumerary teeth (ST) are developmental anomalies that may interfere with eruption, alignment, and occlusal balance. Their etiopathogenesis and management remain controversial. This multicentric study aimed to evaluate the epidemiological, morphological, and radiographic features of ST in a Romanian population and identify impact predictors. Methods: Between January 2020 and March 2025, 153 consecutive patients (91 males, 62 females; mean age 14.8 ± 6.2 years) with clinically and radiographically confirmed supernumerary teeth were evaluated across three Romanian academic centers: the University Dental Clinic, George Emil Palade University of Medicine, Târgu Mureș (n = 78 patients); the Department of Periodontology, Lucian Blaga University of Sibiu (n = 45 patients); and the Department of Dentistry, Dimitrie Cantemir University of Târgu Mureș (n = 30 patients). Results: A total of 185 ST were recorded, most frequently conical (48.6%) and mesiodens (56.2%). Complications were observed in 40.5% of patients. Multivariable analysis identified Angle Class III malocclusion (OR = 1.89; p = 0.039) and tuberculate morphology (OR = 2.93; p = 0.021) as the strongest independent predictors of impaction, alongside associations with younger age (<13 years) (OR = 3.12; p = 0.003) and male gender (OR = 1.78; p = 0.046). CBCT demonstrated high diagnostic concordance with OPG (κ = 0.89), but showed superior performance for complex cases, identifying 11 root resorptions and 9 vestibulo-palatal displacements that OPG missed. Multivariable analysis identified Angle Class III malocclusion (OR = 1.89; p = 0.039) and tuberculate morphology (OR = 2.93; p = 0.021) as the strongest independent predictors of impaction, alongside associations with younger age (<13 years) (OR = 3.12; p = 0.003) and male gender (OR = 1.78; p = 0.046). Conclusions: This multicentric study provides updated Romanian data and highlights novel risk factors and diagnostic selection guidelines that may support individualized treatment planning. Angle Class III malocclusion is a novel and critical independent predictor of supernumerary tooth impaction, alongside tuberculate morphology. This finding strengthens the rationale for utilizing CBCT specifically in Class III patients with ST to pre-emptively manage complex impactions and associated pathology. Full article

Background: The aim of this study was to evaluate the correlation between skeletal class and morphological patterns of the mandibular symphysis. Methods: The sample consisted of 90 patients with an average age of 18 years (44 > x > 12). In order to investigate any correlation between skeletal class and morphological patterns of the mandibular symphysis, the following tests were used: Pearson’s correlation test, Spearman’s test, and the analysis of variance test (ANOVA) followed by Tukey’s post hoc HDS test. The significance level was set at 0.050. Results: Pearson’s correlation test and ANOVA showed a weak negative correlation between malocclusion and symphyseal height. Therefore, as ANB increases, symphyseal height decreases (r = −0.25, p < 0.01). In addition, a strong positive correlation was found between ANB and IMPA (r = 0.47, p < 0.01). So, as ANB increases, IMPA increases. No statistically significant association was found between symphyseal morphology and IMPA (Spearman’s test). Conclusions: The analysis revealed a weak but statistically significant negative correlation between ANB angle and symphysis height, indicating that as sagittal discrepancy increases (higher ANB), the symphysis tends to be shorter (r = −0.25, p < 0.01). A moderate positive correlation was also found between ANB and IMPA (r = 0.47, p < 0.01), suggesting that a more pronounced Class II skeletal pattern is associated with greater incisor proclination. However, no significant relationship was observed between symphysis type (A/B/C) and IMPA. When comparing skeletal classes, Class III subjects displayed significantly greater symphyseal height than Class II subjects (p < 0.001), while Class II subjects showed the highest IMPA values (p < 0.001). Full article

Background: Class III malocclusion presents complex craniofacial growth patterns, yet longitudinal evidence remains limited compared with Class I malocclusion. This study compared skeletal and dental changes in children with untreated Angle Class I and Class III malocclusions. Methods: Forty-eight untreated children (24 Angle Class I and 24 Angle Class III) from the AAOF Craniofacial Growth Legacy Collections were included. Lateral cephalograms were taken at ages 4–5 (T0), 7–8 (T1), 10–11 (T2), and 13–14 (T3). Because the radiographs originated from heterogeneous mid-20th-century X-ray equipment with unknown magnification factors, only angular measurements were used. Cephalometric tracing was conducted using WebCeph™ software with good-to-excellent intra-examiner reliability (κ = 0.71–0.98). Growth changes were assessed using three-way repeated-measures ANOVA, with effect sizes (ηp²), mean differences (MDs), and 95% confidence intervals (95% CI) calculated. Results: Significant differences in growth patterns were observed between the groups. Class III children showed greater FMA (MD = 6.0°, 95% CI [2.3, 9.7], p < 0.05) and gonial angles (MD = 8.1°, 95% CI [3.4, 12.8], p < 0.01) at T3, alongside a progressive decrease in ANB (MD = −2.6°, 95% CI [−5.5, −0.3], p < 0.01) and A–B mandibular angles (MD = −9.5°, 95% CI [−13.1, −5.9], p < 0.05). Class III children also exhibited significant upper incisor proclination and lower incisor retroclination (p < 0.001) compared to Class I children. No sex-related differences were observed, except for an SNA angle increase among Class I males (p < 0.05). Conclusions: Distinct craniofacial growth trajectories were observed between malocclusion classes, with Class III children showing progressive sagittal and vertical divergence from normal growth. The results highlight the need for early detection and monitoring of those at risk for pronounced Class III patterns. Full article

Background/Objective: This study aimed to evaluate the strain values (SVs) of masseter muscle activity in dentofacial deformities (DDs) using ultrasound elastography. Methods: The DD group consisted of 60 patients with dentofacial deformities with skeletal class II or III malocclusion, and the control group consisted of 26 volunteers with normal occlusion. The SVs and the cross-sectional area of the masseter muscle were measured using an ultrasonic elastography. These were measured at three functional positions: resting, mouth opening, and clenching. The SVs were statistically compared with the DD and control groups. Changes in the cross-sectional area and factors (patient status, skeletal morphology, and oral function) related to the SVs in the study group were statistically analyzed. Results: The SVs were significantly higher during clenching than in resting and mouth opening in both groups, although there was no correlation between the DD group and the control group. The cross-sectional area was larger during clenching, resting, and mouth opening. The resting SVs decreased as the masseter muscle cross-sectional area increased. The SVs of clenching increased with higher resting SVs and decreased with greater maximum mouth opening. Conclusions: The SVs measured by ultrasound elastography changed depending on functional mandibular movement and have the potential to evaluate the masseter muscle activity of dentofacial deformities. Full article

Predicting treatment outcomes in Class III protraction therapy remains challenging. Although finite element analysis (FEA) helps in the study of biomechanics and planning of orthodontic treatment, its use in Class III protraction has mainly been in evaluating appliance designs rather than patient-specific anatomy. The predictive accuracy of FEA has not been validated in Class III protration therapy. In this study, ten patients (5 female, 5 male, aged 7–11 years) with Class III malocclusion received either facemask or mentoplate treatment. CT scans from four patients were used to construct simplified finite element models, and predictions were compared with one-year treatment outcomes from six additional patients. While stress patterns differed between treatments, patient-specific geometrical factors had a more significant impact on deformation than treatment type. FEM-predicted maxillary changes (mean: 0.352 ± 0.12 mm) were approximately one-tenth of actual changes (mean: 1.612 ± 0.64 mm), with no significant correlation. Current FEM approaches, though useful for understanding force distribution, cannot reliably predict clinical outcomes in growing Class III patients. The findings suggest that successful prediction models must incorporate biological and growth factors beyond pure biomechanics. Accurate prediction of treatment outcomes requires comprehensive models that integrate multiple biological and developmental factors. Full article

Background: Orthognathic surgery aims to align the jaws with the facial skeleton and correct dental occlusion. This paper introduces the concept of planning the maxillomandibular complex (MMC) as a whole, utilizing a t-forming set of landmarks: the maxillary central incisor, the chin, and the occlusal plane. Methods: The background, hypothesis, and rationale of the new T concept are explained. A case of a 28-year-old male with skeletal class III malocclusion and an open bite was used to illustrate the application of the T concept in step-by-step surgical planning. The planning encompasses four phases: Phase One involves correcting frontal deformity and various asymmetries, Phase Two involves correcting chin anterior–posterior deformity, Phase Three involves correcting anterior–posterior and vertical MMC position, and Phase Four involves correcting MMC rotation. Results: The T concept provided a structured approach to plan MMC as a whole and integrate all structures into harmony. Conclusions: The T concept provides a logical approach to MMC positioning in orthognathic surgery, addressing functional and aesthetic concerns. It acts as a checkpoint to verify MMC position, helping surgeons achieve better results and avoid compensatory procedures. Full article