Search Results (190)

Objectives: The present study aimed to evaluate the sexual dimorphism of skeletal and dental anomalies in Romanian orthodontic patients and to describe several important cephalometric measurements in patients with dental malocclusions. Materials and Methods: A total of 450 orthodontic records of patients older than 8 years were evaluated. On lateral cephalometric radiographs, the following cephalometric angles were digitally determined: SNA, SNB, ANB, FMA, IMPA, Max1-FH, SN-Go-Gn, N-A-Pog, Ar-Go-Me, and interincisal angle. The sagittal skeletal and dental malocclusions were diagnosed by two calibrated investigators. Results: The sample comprised 58% females, with a mean age of 20.07 (±8.63) years. The prevalence of dental malocclusions within the Romanian orthodontic sample taken into study was: 50.7% class I, 26.7% class II division 1, 13.3% class III, 4.7% class II, and class II division 2. The prevalence of skeletal anomalies within the Romanian orthodontic patient sample was: 43.3% class I, 28.7% class II due to retrognathic mandible, 17.3% class II due to prognathic maxilla, 8.7% class III due to prognathic mandible, and 2% class III due to retrognathic maxilla. Female patients presented more frequently with Class I or Class II division 2 malocclusion, whereas male patients more frequently exhibited Class III malocclusion. Female patients exhibited skeletal Class II more frequently due to retrognathic mandible, while skeletal Class III, due to prognathic mandible, was more common in male patients. Male patients were more frequently normodivergent, while female patients were more frequently hyperdivergent. Female patients exhibited retroclined upper incisors more frequently, whereas male patients exhibited proclined upper incisors more frequently. Most of the patients with class II division 1 malocclusion were females and exhibited the following cephalometric characteristics: a class II skeletal anomaly due to retrognathic mandible, normal SNA angle, decreased SNB angle, increased ANB angle, proclined upper incisors, proclined lower incisors, decreased interincisal angle, normal vertical growth pattern, closed mandibular angle, and convex facial profile. Most of the patients with class II division 2 malocclusion were females and exhibited the following cephalometric characteristics: a class II skeletal anomaly due to retrognathic mandible, normal SNA angle, decreased SNB angle, increased ANB angle, retroclined upper incisors, proclined lower incisors, increased interincisal angle, hypodivergent vertical growth pattern with a short face tendency, closed mandibular angle, and convex facial profile. Most of the patients with class III malocclusion were males and exhibited the following cephalometric characteristics: both class I and III skeletal anomaly due to prognathic mandible, normal SNA angle, increased SNB angle, decreased ANB angle, proclined upper incisors, normally inclined lower incisors, increased interincisal angle, hypodivergent, normal vertical growth pattern, and a short face tendency, normal mandibular angle, and balanced facial profile. Conclusions: The observed cephalometric differences between Class I, II and III malocclusions provide clinically relevant markers in vertical, sagittal, and dental dimensions that may provide descriptive reference data for similar orthodontic clinical samples. Full article

Background/Objectives: Fibrodysplasia ossificans progressiva (FOP) is an ultra-rare genetic disorder causing progressive heterotopic ossification. The dental phenotype has never been systematically characterised. We quantified dental pathologies and oral health-related quality of life across three age groups of genetically confirmed FOP patients and compared them with 156 matched healthy controls (2022–2025). Methods: A total of 52 FOP patients (Group I: 1–5 y, n = 14; Group II: 6–17 y, n = 21; Group III: 18–35 y, n = 17) underwent standardised dental examination (Decayed, Missing, and Filled Teeth index (DMFT), Oral Hygiene Index Simplified (OHI-S), Angle classification, temporomandibular joint (TMJ) assessment), computed tomography (CT) densitometry, sialometry, salivary crystal analysis, and Oral Health Impact Profile-14 (OHIP-14). Statistical analysis used Kruskal–Wallis, Mann–Whitney U, Benjamini–Hochberg false discovery rate (FDR) correction, and effect sizes. Results: Caries (DMFT ≥ 4) was highly prevalent across all FOP groups (82–86%) and significantly higher than in controls (84.6% vs. 38.5%, p < 0.001). Chronic stomatitis showed large age-group differences: 7.1% in Group I vs. 100% in Group III (p < 0.001); it was universal in FOP adults vs. 6.4% in controls. Enamel hypoplasia (21.4% → 58.8%) and Angle class II malocclusion (0% → 47.1%) also showed large age-group differences. Total TMJ disorders were observed in 7.1% of Group I and 100% of Group III (p < 0.001); maximal mouth opening was lower by 17.4 mm in Group III (Cohen’s d = 2.1). Salivary flow rate was 20% lower in adults (0.35 → 0.28 mL/min, p = 0.01). Calcium phosphate crystals were detected in 3/17 adults (17.6%) and showed a preliminary correlation with CT calcification grade (ρ = 0.67, p = 0.003); given the small number of crystal-positive patients, this finding should be considered hypothesis-generating. OHIP-14 total score was higher (worse) in Group III (48.9 vs. 12.4 in Group I, Cohen’s d = 1.95). Conclusions: This cross-sectional study provides a systematic characterisation of the dental phenotype in FOP across three age groups. It shows that chronic stomatitis and TMJ dysfunction become nearly universal by early adulthood, severely impairing quality of life. The correlation between salivary calcium phosphate crystals and CT calcification generates the hypothesis of a non-invasive biomarker, requiring prospective validation. The proposed clinical phenotype and minimally invasive recommendations provide a framework for safer dental management of FOP patients. Full article

Dental malocclusions are common and often underdiagnosed situations in dogs, which might result in oral trauma, impaired mastication, and periodontal disease. Nevertheless, scientific investigations into breed-specific variations in dentition remain scarce. To evaluate breed-specific dental variations in dogs, a retrospective cross-sectional analysis was conducted on 92 clinical canine head computed tomography (CT) scans obtained in Chengdu, China, representing a range of breeds and skull morphologies. Dental alignment and occlusal relationships were calculated using standardized malocclusion classification criteria. As a result, malocclusions were found and identified in 46.7% of dogs. Among them, brachycephalic breeds indicated a high prevalence of malocclusion, with Shiba Inu dogs demonstrating the highest malocclusion rate (66.7%), whereas Golden Retrievers and Akitas showed the lowest prevalence (16.7%). Class I malocclusions characterized by dental crowding were most common (44.19%), followed by Class II malocclusions (overbite) (30.23%), and Class III malocclusions (underbite) (20.93%). Our findings demonstrated a strong association between skull morphology and dental alignment abnormalities. Full article

Background: Orthodontic camouflage in Class III patients is a widely used treatment approach. However, its application is subject to specific clinical indications. This narrative review aims to synthesize the current scientific evidence and provide an overview of the available methods, their advantages and limitations, in order to guide the appropriate management of Class III camouflage cases. Methods: A literature search was carried out using five main scientific databases without restrictions. Inclusion criteria were all types of articles published on various orthodontic camouflage techniques for Class III malocclusion in adult patients. The string searches included “camouflage” and “Class III malocclusion”. In addition, a manual search was performed to identify further relevant articles. The methodological quality was assessed using the Oxford Centre for Evidence-Based Medicine (OCEBM) classification. Results: This narrative review synthesizes 128 studies on orthodontic camouflage in adult Class III malocclusion. Among the 128 articles included, 110 (86%) were case reports or small case series, corresponding to level 4–5 evidence. The remaining studies were observational in design, most of them retrospective, corresponding to level 2–3 evidence. Extractive or non-extractive treatment can be used for non-surgical treatment of a Class III in adults. In recent years, aesthetic techniques, such as clear aligners or lingual fixed appliances, have been efficiently performed. Carriere Motion III is a fast and efficient method to mask a Class III occlusal relationship. Moreover, the use of temporary anchored devices (TADs) has proven to be an effective and minimally invasive method for managing mandibular distalization and a retraction of the lower incisors. Conclusions: Although most reports are case-based, recent advances such as TADs and clear aligners offer effective non-surgical alternatives for selected mild-to-moderate cases. Careful patient selection remains critical. The evidence was low-quality, and further prospective studies are needed. Full article

Background: Accurate transfer of the surgical plan is essential in bimaxillary orthognathic surgery, where small discrepancies between planned and postoperative skeletal positions may influence functional and aesthetic outcomes. This study compared the three-dimensional (3D) accuracy and time efficiency of conventional and fully digital planning workflows using CBCT-based evaluation. Methods: This retrospective comparative study included 100 adult patients with skeletal Class II or III malocclusion treated by Le Fort I osteotomy combined with bilateral sagittal split osteotomy (BSSO). Patients were allocated to conventional planning (n = 50) or fully digital planning using IPS CaseDesigner (n = 50). Planned and postoperative CBCT datasets were superimposed using voxel-based cranial base registration. Linear deviations at A-point and Pogonion, total RMS error, planning time, and operative time were analyzed. Results: Mean deviations were lower in the digital group at A-point (1.28 ± 0.28 mm vs. 1.63 ± 0.36 mm) and Pogonion (1.49 ± 0.42 mm vs. 1.95 ± 0.44 mm) (p < 0.001). Total RMS deviation was reduced in the digital workflow (1.39 ± 0.39 mm vs. 1.80 ± 0.54 mm; p < 0.001). Planning and operative times were significantly shorter in the digital group (p < 0.001). Moderate correlations were observed between time variables and 3D deviations. Conclusions: Fully digital planning showed improved 3D accuracy and significantly reduced planning and operative times compared with conventional methods, while maintaining clinically acceptable deviations. Full article

Background: This retrospective case series evaluated the descriptive clinical observations of the bio-activator AMCOP^® TC in the treatment of growing patients with Class III dento-skeletal malocclusion. In recent years, elastodontic appliances have been introduced as an evolution of conventional functional appliances. Elastodontic therapy could be an excellent therapeutic alternative in the early treatment of patients with Class III dento-skeletal malocclusion. Aim: This retrospective experimental study evaluated the descriptive clinical observations of the bio-activator AMCOP^® TC in the treatment of patients with Class III dento-skeletal malocclusion and described four clinical cases. Materials and methods: The study included 11 subjects (5 males and 6 females, aged between 3 and 12 years) treated with the AMCOP^® TC bio-activator for Class III dento-skeletal malocclusion. Patients used the AMCOP^® TC device for two hours in the afternoon and all night for 6–8 months and then only at night. For each patient, cephalometric analyses were performed on latero-lateral teleradiographs both at the beginning of treatment (T0) and at the end of treatment (T1). Analyses were performed using DeltaDent^® software. Conclusions: Cephalometric observations between T0 and T1 showed changes in sagittal relationship parameters, including ANB values; however, these findings should be interpreted cautiously. Elastodontic therapy with an AMCOP^® TC appliance improved the correction of a Class III dento-skeletal malocclusion and postural restoration of the first cervical vertebrae. Although further studies are needed, AMCOP^® TC bio-activators may be considered a possible interceptive treatment approach in selected growing patients; however, the present findings should be interpreted with caution. Findings should be considered preliminary and interpreted with caution. Full article

Advanced cases of unilateral condylar hyperplasia might need combined joint reconstruction and orthognathic surgery. This report illustrates the feasibility of integrating digital planning, patient-specific prosthesis design, and orthognathic correction within a single-stage surgical workflow. A 23-year-old female patient presented with skeletal Class III malocclusion, facial asymmetry, and mandibular midline deviation due to left condylar hyperplasia. After preoperative orthodontic alignment, virtual surgical planning was carried out using specialised software to simulate resection of the hyperplastic condyle, with concurrent total TMJ replacement, contralateral sagittal split ramus osteotomy, and Le Fort I osteotomy. Based on this plan, patient-specific prosthetic components, surgical guides, and fixation plates were designed and manufactured. Surgery was performed according to the digital plan using a combined intraoral and extraoral approach. At 3-month follow-up, clinical and radiological assessments showed stable prosthesis positioning, improved occlusal relationships, restoration of facial symmetry, and high patient-reported satisfaction. However, given the single-case design and short follow-up, these findings should be considered preliminary, and further studies are necessary to evaluate long-term functional outcomes and reproducibility. Full article

Background: Management of skeletal Class III malocclusion of maxillary origin in late adolescence remains challenging, as conventional tooth-borne orthopedic approaches show reduced effectiveness at advanced stages of skeletal maturation. Minimally invasive, bone-anchored alternatives supported by digital workflows may improve clinical feasibility and patient acceptance. Objective: To describe a digitally guided clinical protocol combining a hybrid maxillary expander and supragingival mandibular miniplates, and to explore skeletal and dentoalveolar outcomes in late adolescents. Methods: This retrospective pilot clinical study included ten late adolescents (mean age 16.0 ± 1.3 years; range 13.8–17.7) in advanced skeletal maturation stages (CS4–CS6) with skeletal Class III malocclusion of maxillary origin. Treatment consisted of a hybrid maxillary expander anchored to palatal miniscrews and custom supragingival mandibular miniplates, placed using a fully digital workflow. Maxillary protraction was performed using a modified Alt-RAMEC protocol followed by continuous intermaxillary elastic traction for 12 months. Pre- and post-treatment cephalometric analyses were conducted. Results: A significant increase in SNA was observed (mean +6.1°, p < 0.001), indicating forward maxillary displacement. The Wits appraisal improved by 3.3 mm (p = 0.007), and the SeMax increased by 2.9 mm (p = 0.0013). No significant changes were found in the SNB or mandibular plane angle. Dentoalveolar effects were limited. Conclusions: Within the limitations of this pilot clinical study, the proposed digitally guided protocol demonstrated clinically relevant maxillary advancement with minimal dentoalveolar side effects and preserved vertical control. This relatively minimally invasive approach compared to conventional subgingival miniplates and orthognathic surgery may represent a feasible treatment option for selected late adolescent patients. Further controlled studies are required to confirm these findings. Full article

Background/Objectives: This study aimed to evaluate the immediate effects of a 2-hinged expander activated with the alternate rapid maxillary expansion–constriction (Alt-RAMEC) protocol on craniofacial structures and the soft tissue periodontium in adolescents with skeletal Class III malocclusion characterized by maxillary retrusion. Methods: Lateral cephalograms obtained at baseline (T0) and immediately after treatment (T1) from 15 adolescents (6 females, 9 males; mean ages 12.6–13.1 years) treated with a 2-hinged expander using a 9-week Alt-RAMEC protocol were analyzed. A control group consisted of 27 untreated Class III individuals (7 females, 20 males; mean ages 12.5–12.6 years). Sagittal and vertical skeletal, dental, and soft tissue measurements were assessed using a Cartesian coordinate system. Periodontal parameters of supporting teeth were evaluated at T0 and T1. Statistical analysis was performed using the Mann–Whitney U and Wilcoxon tests (p < 0.05). Results: Significant anterior maxillary displacement was observed in the treatment group compared with controls (p < 0.01), accompanied by increases in overjet and Wits appraisal (p < 0.05), while mandibular position remained unchanged. The upper lip advanced in accordance with skeletal changes (p < 0.05). Gingival index, bleeding index, and probing pocket depth increased significantly in supporting teeth (p < 0.05), whereas plaque index remained stable (p > 0.05). Conclusions: The 2-hinged expander combined with a 9-week Alt-RAMEC protocol induces immediate skeletal maxillary advancement in growing Class III patients with minimal dental compensation. Short-term periodontal changes suggest a transient inflammatory response associated with appliance therapy. Full article

Objective: To investigate the effects of three-bite plane appliance (TBP) therapy on maximal occlusal force (MOF) in growing patients. Methods: This study included 120 children (aged 9–10 years) diagnosed with Class I, Class II, or Class III malocclusion. All subjects presented with a deep bite and a normodivergent growth pattern. MOF was recorded at baseline (T0) and after 12 months of treatment (T1). A standardized multi-bite protocol was used to improve reproducibility. Paired t-tests or Wilcoxon tests assessed intragroup differences, while Welch’s ANOVA with Games–Howell post hoc testing evaluated intergroup variation. Results: Significant intragroup differences were found for all groups (p < 0.001). Class I subjects demonstrated a reduction in MOF (Δ = −138.3 N; p < 0.001), whereas Class II (Δ = 113.35 N; p < 0.001) and Class III (Δ = 145.6 N; p < 0.001) subjects showed significant increases. Intergroup comparison revealed a significant overall difference in MOF change (F = 41.35; p < 0.001). Post hoc analysis confirmed significant differences between Class I and both Class II and III, while no significant difference was detected between Class II and III. Conclusions: Treatment with a three-bite plane appliance modifies MOF in growing patients, showing malocclusion-specific adaptation patterns. The reduction observed in Class I contrasts with the functional enhancement detected in Class II and Class III subjects. Full article

Background/Objectives: Virtual surgical planning (VSP) allows three-dimensional assessment of complex dentofacial deformities and has become integral to modern orthognathic surgery. However, evidence remains limited regarding how skeletal characteristics and malocclusion patterns translate into surgical movement selection. This study aimed to evaluate demographic features, skeletal malocclusion patterns, and clinical treatment strategies in patients undergoing VSP-guided orthognathic surgery. Methods: This retrospective study included 158 patients who underwent VSP-assisted orthognathic surgery between 2019 and 2025. Sagittal skeletal classification, vertical growth pattern, facial asymmetry, and maxillary crossbite were evaluated together with planned maxillary and mandibular movements. Surgical procedures were analyzed according to skeletal malocclusion classes (Class I, II, and III). Group comparisons were performed using chi-square and Kruskal–Wallis tests. Multivariable logistic regression analysis was conducted to assess factors associated with bimaxillary surgery (p < 0.05). Results: Skeletal Class I malocclusion was most prevalent (46.8%), followed by Class III (29.7%) and Class II (23.4%). Hyperdivergent growth patterns were predominantly observed in Class II patients, whereas normodivergent patterns were most common in Class III cases (p < 0.05). Mandibular advancement and setback generally followed expected class-based trends but were also observed across non-corresponding skeletal classes. Maxillary impaction and mandibular autorotation were frequently incorporated. Bimaxillary surgery was performed in 84.2% of cases. Logistic regression analysis showed no independent predictors of bimaxillary surgery (p > 0.05). Conclusions: VSP-assisted orthognathic surgery demonstrates that surgical planning cannot be reduced to sagittal skeletal classification alone. Treatment decisions are shaped by combined sagittal, vertical, transverse, and patient-specific factors, supporting a multidimensional and individualized planning approach. Full article

Background/Objectives: This study aims to evaluate mandibular condylar asymmetry in individuals with different types of skeletal malocclusions using a three-dimensional imaging technique, and to determine the relationship between these anomalies and condylar asymmetry. Methods: The study included 100 individuals who visited the Department of Orthodontics Faculty of Dentistry between 2015 and 2020 and underwent Cone-Beam Computed Tomography (CBCT) imaging for various reasons. The evaluation of condylar asymmetry was performed using the Habets method, and measurements were carried out with the NemoCeph V.2017 software. Participants were categorized into skeletal Class I (2–4°), Class II (>4°), and Class III based on their ANB angles. For statistical analysis, frequency distribution, the Kruskal–Wallis H test, and Spearman’s correlation coefficient were used. Results: No statistically significant relationship was found between gender and skeletal classifications (p > 0.05). In terms of age, the mean age of individuals in the Class III group was significantly lower than that of those in the Class II group (p < 0.05). A weak positive correlation was observed between condylar and ramal indices in the overall sample (p = 0.029); however, this correlation was found to be moderate and statistically significant only within the Class III group (p = 0.002). Conclusions: The presence of a significant relationship between condylar and ramal asymmetries in individuals with Class III malocclusion indicates an increased risk of developing facial asymmetry if left untreated. These findings underscore the importance of skeletal malocclusions in influencing condylar morphology. Full article

Objective: This study aimed to evaluate the relationship between craniocervical posture and skeletal malocclusion patterns in adolescents. Methods: This cross-sectional study included 80 adolescents aged 10–15 years diagnosed with skeletal Class I, Class II Division 1, Class II Division 2, or Class III malocclusion. Postural parameters—Sagittal Head Angle (SHA), Craniocervical Angle (CA), and Shoulder Angle (SA)—were assessed using standardized sagittal-plane digital photographs obtained in Natural Head Position. Skeletal classification and cephalometric measurements (SNA°, SNB°, ANB°, GoGn/SN°, and Occlusal Plane/SN°) were determined from lateral cephalometric radiographs. Intergroup comparisons were performed using the Kruskal–Wallis test, and posture–skeletal relationships were evaluated using Pearson and Spearman correlation analyses (p < 0.05). Results: No significant differences were observed in postural parameters among skeletal malocclusion classes (p > 0.05). In the overall sample, SHA showed weak negative correlations with SNA° (r = −0.284, p < 0.01) and SNB° (r = −0.381, p < 0.01), and a weak positive correlation with Occlusal Plane/SN° (r = 0.235, p < 0.05). No significant associations were identified for CA or SA. Subgroup analysis demonstrated that these associations were present exclusively in the Class II Division 2 group, where SHA showed strong negative correlations with both SNA° (r = −0.653, p < 0.01) and SNB° (r = −0.605, p < 0.01). Conclusions: Sagittal head posture may show phenotype-specific associations during adolescence, particularly in Class II Division 2 malocclusion. Incorporating postural assessment into orthodontic evaluation may enhance diagnostic understanding during growth. Full article

Objective: External apical root resorption is a frequent complication of orthodontic treatment, and the response of endodontically treated teeth remains controversial. This study aimed to compare external apical root resorption (EARR) in endodontically treated teeth and vital teeth following fixed orthodontic treatment in patients with Angle Class I, II, and III malocclusions using digital panoramic radiography. Methods: This retrospective longitudinal study included 60 patients (mean age: 16.3 ± 2.4 years) who underwent non-extraction fixed orthodontic treatment. A paired contralateral within-subject design was used, whereby each patient contributed one endodontically treated tooth and its symmetrical untreated vital counterpart. Root length was measured on calibrated panoramic radiographs obtained before (T0) and after treatment (T1). Differences were analyzed using the Wilcoxon signed-rank and Kruskal–Wallis tests (p < 0.05). Results: Both endodontically treated and vital teeth exhibited statistically significant reductions in root length between T0 and T1 (mean reduction: 1.02 ± 1.36 mm and 1.11 ± 1.79 mm, respectively; p < 0.001). No significant difference was observed between the two tooth types regarding the magnitude of resorption. Similarly, no significant differences were detected among Angle Class I, II, and III malocclusion groups. The observed mean reduction of approximately 1 mm suggests limited apical shortening within the range generally considered clinically moderate. Conclusions: Endodontically treated teeth exhibited a degree of EARR comparable to that of vital teeth following fixed orthodontic treatment, suggesting that properly treated endodontic teeth do not pose an increased risk of clinically relevant apical root resorption during orthodontic therapy. Full article

Objective: This retrospective comparative cohort study investigated the craniofacial growth effects of the RAMPA (Right Angle Maxillary Protraction Appliance) system. The system aims to protract the maxilla in an anterosuperior direction to address maxillary hypoplasia and skeletal Class III malocclusion, potentially mitigating the posteroinferior displacement often associated with conventional orthopedic approaches. Materials and Methods: Craniofacial measurements were analyzed before (T1) and after (T2) RAMPA treatment in 30 growing patients (17 males, mean age 7.32 years; 13 females, mean age 8.34 years). Coben analysis was utilized to quantitatively evaluate coordinate relationships and proportional changes based on the Frankfurt Horizontal plane. Statistical significance was determined using paired t-tests or Wilcoxon signed-rank tests (two-sided, α = 0.05) without adjustment for multiple comparisons due to the exploratory nature of the study. Results: RAMPA treatment was associated with significant increases in facial depth (Ba-N) and anterior facial height (N-Me) in both sexes. Specifically, facial depth increased by an average of 2.65 mm in males (p = 0.001) and 2.18 mm in females (p = 0.007). Female patients showed a significant increase in the maxillary depth ratio (Ptm-A/Ba-N), while males exhibited a significant decrease in the Gonial Angle (avg. 1.47° decrease), suggesting anterior mandibular rotation. Conclusions: RAMPA treatment effectively promoted anterosuperior craniofacial growth and induced favorable mandibular rotation in this cohort. These findings suggest the system has potential clinical value for improving craniofacial balance in skeletal Class III malocclusion. While improved cervical posture is a theoretical benefit of such remodeling, systemic outcomes were not directly measured in this study. Full article