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To investigate the carbon footprint of bamboo-based activated carbon from different manufacturing pathways, this research evaluated cradle-to-gate manufacturing emissions under a unified system boundary and allocation baseline based on primary data from a 10,000 t/year continuous industrial production line. An LCA model was constructed and verified using an allocation ratio interval scanning method. Results showed that carbon footprints of granular, powdered, and extruded activated carbons were 184.76 kg CO₂ e/t kg CO₂ e/t, 236.75 kg CO₂ e/t, and 293.36 kg CO₂ e/t. Although these products shared identical carbonization and steam activation units, the carbon footprints from milling, molding, and binder inputs accounted for 25.01%, 41.48%, and 52.77% of the total emissions. Internal thermal energy recovery via by-product gas recycling decreased emissions by 81.7%, 77.7%, and 73.8%, respectively. Compared with traditional coal-based alternatives, bamboo-based products achieved a reduction in emissions of about 95%. This study provides scientific guidance for the low-carbon production process of bamboo-based activated carbon and demonstrates the potential of biomass substitution for climate change mitigation. Full article

(This article belongs to the Special Issue Forest-Based Materials, Wood Science, Biocomposite Materials and Circular Bioeconomy—Selected Papers from INNO’2026)

39 pages, 1054 KB

Open AccessReview

Regulating Glucose Metabolism Enzymes for Osteoporosis Therapy: Current and Future Approaches

by Ziwen Zhang, Shuo Tian, Qian Li, Xiuwei Du, Linhui Wang, Na Li, Feng Zhao and Yanqiu Liu

Int. J. Mol. Sci. 2026, 27(10), 4536; https://doi.org/10.3390/ijms27104536 (registering DOI) - 18 May 2026

Abstract

Osteoporosis is a systemic skeletal disorder characterized by low bone mass, microarchitectural deterioration, and an increased risk of fracture. Its pathogenesis is closely associated with disturbances in energy metabolism, particularly glucose metabolic reprogramming in bone cells. Under osteoporotic conditions, the balance between osteoblasts and osteoclasts is disrupted, accompanied by impaired oxidative phosphorylation, dysregulated glycolysis, and reduced tricarboxylic acid cycle efficiency, ultimately leading to mitochondrial dysfunction. These metabolic alterations result in an insufficient energy supply and accelerate bone loss. Accordingly, the modulation of key enzymes involved in glucose metabolism has emerged as a promising therapeutic strategy. Strategies include the use of natural compounds, traditional Chinese medicine formulas, and specific inhibitors to modulate glucose metabolism processes and related pathways, thereby restoring cellular energy homeostasis and bone remodeling balance. This review summarizes pharmacological agents regulating glucose metabolism and proposes a hierarchical framework for therapeutic prioritization: first, inhibiting pathological glycolysis in osteoclasts (particularly via LDHA and PKM2). Second, restoring oxidative phosphorylation in osteoblasts (e.g., via COX I–V or ATP synthase). And third, employing multi-target traditional Chinese medicine formulas as complementary strategies. By establishing this cell-type-specific and pathway-specific hierarchy, the review aims to provide a theoretical basis for future research on metabolic interventions in bone diseases. Full article

(This article belongs to the Special Issue 25th Anniversary of IJMS: Advances in Molecular Endocrinology and Metabolism)

20 pages, 2201 KB

Open AccessArticle

The Effects of Tributyrin on Immune Function, Antioxidant Capacity, and Metabolomics in Young Pigeons

by Run Wu, Lihuan Deng, Haiying Li, Yingying Yao, Yingping Wu, Qingqing Lu, Gaoyun You and Tinghao Jiang

Animals 2026, 16(10), 1547; https://doi.org/10.3390/ani16101547 (registering DOI) - 18 May 2026

Abstract

Tributyrin, a short-chain fatty acid derivative, has been shown to hold potential in improving intestinal health in livestock and poultry. However, its multidimensional effects on the health of meat pigeons, particularly during the young pigeon stage, remain unclear. This study aimed to investigate the comprehensive effects of dietary tributyrin supplementation on the growth, health status, intestinal function, and metabolic profile of young pigeons. A total of 100 healthy 29-day-old White King pigeons, with half male and half female, were randomly divided into a control group (fed a basal diet) and a treatment group (fed a basal diet supplemented with 1500 mg/kg tributyrin) for a 35-day trial. The results showed that compared with the control group, young pigeons in the treatment group had significantly reduced serum triglyceride levels, alanine aminotransferase activity, and concentrations of pro-inflammatory cytokines (TNF-α, IL-6), along with significantly increased levels of high-density lipoprotein, immunoglobulin G, total antioxidant capacity, and glutathione peroxidase activity. Concurrently, the villus height-to-crypt depth ratio in the jejunum and ileum was significantly elevated, indicating improved intestinal morphological structure. Untargeted metabolomics analysis further revealed significant changes in the relative abundances of 13 key differential metabolites (e.g., L-carnitine, pyridoxamine, indoleacetic acid) in the small intestinal contents of the treatment group. These metabolites were mainly enriched in metabolic pathways such as 2-oxoCarboxylic acid metabolism, tryptophan metabolism, and vitamin B6 metabolism. In conclusion, dietary supplementation with 1500 mg/kg tributyrin can exert multifaceted beneficial effects on young pigeon health by improving lipid metabolism, enhancing immune and antioxidant functions, optimizing intestinal structure, and regulating the local metabolic network. This study provides a theoretical basis for the application of tributyrin as a functional additive in the green and healthy production of meat pigeons. Full article

(This article belongs to the Special Issue Innovations in Sustainable Animal Nutrition: From Feed Evaluation to Precision Feeding)

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13 pages, 524 KB

Open AccessArticle

Increasing HPV Vaccination Among Early Adolescents Using a Game-Based Digital Intervention: A Randomized Controlled Trial

by Angela Chia-Chen Chen, Lihong Ou, Elizabeth Reifsnider, Kimberly Arcoleo, Ashish Amresh and Michael Todd

Vaccines 2026, 14(5), 448; https://doi.org/10.3390/vaccines14050448 (registering DOI) - 18 May 2026

Abstract

Background/Objectives: Human papillomavirus (HPV) vaccination coverage among adolescents remains below public health targets despite strong evidence of vaccine effectiveness in preventing HPV-related cancers. Digital interventions (e.g., serious games) may improve HPV vaccine uptake, but evidence for effects on vaccination behavior remains limited. Methods: This secondary analysis of a randomized controlled trial evaluated a co-designed, game-based digital intervention to increase HPV vaccine initiation among unvaccinated youth aged 11–14 years and their parents. The sample included 64 parent–adolescent dyads (33 intervention and 31 usual care dyads). The primary outcome was HPV vaccine initiation at 2-month follow-up. Results: A significantly greater proportion of adolescents in the intervention group initiated HPV vaccination compared with controls (88.5% vs. 46.2%; χ²(1) = 10.58, p = 0.001; risk difference = 0.423, 95% CI = [0.196, 0.650]). No significant between-group baseline differences were observed in parent HPV vaccination intention, knowledge, or psychosocial perceptions, although adolescent vaccination intention was higher in the intervention group. In adjusted logistic regression controlling for adolescent baseline HPV vaccination intention, intervention participants remained significantly more likely to initiate vaccination than controls (OR = 9.31, 95% CI = 2.13–40.70, p = 0.003). Intervention acceptability was high, with most parents and adolescents reporting that the game was easy to use, engaging, and relevant to vaccination decision-making. Conclusions: These findings provide preliminary evidence that a brief, family-centered, game-based digital intervention may help increase HPV vaccination initiation among adolescents. Larger trials with longer follow-up are needed to assess vaccine series completion and effectiveness across diverse settings. Full article

(This article belongs to the Special Issue Research and Significance of Vaccines Against Sexually Transmitted Diseases)

10 pages, 1375 KB

Open AccessArticle

Ab Initio Investigation of the M Segregation on PdM (M = Co, Ru, Pt) Alloys with Chemisorbed Atomic Oxygen

by Yanlin Yu, Yuanxun Li, Yufeng Wen, Renmei Zhang and Qiuling Huang

Catalysts 2026, 16(5), 469; https://doi.org/10.3390/catal16050469 (registering DOI) - 18 May 2026

Abstract

Surface segregation in metal alloys critically determines their electrocatalytic performance, yet how chemisorbed oxygen alters segregation behavior under reaction conditions remains poorly understood. Using density functional theory, we quantify the segregation energies on the (111) surface of PdM (M = Co, Ru, Pt) alloys with chemisorbed atomic oxygen. In vacuum, all three alloying elements exhibit positive segregation energies (0.28 eV for Co, 0.40 eV for Ru, and 0.04 eV for Pt) on the topmost layer, indicating that surface segregation is energetically unfavorable. Upon oxygen adsorption, however, this trend reverses for Co and Ru: their segregation energies shift by −0.18 eV and −0.33 eV, respectively, driving these atoms strongly toward the surface. In contrast, Pt shows only a marginal shift of 0.03 eV, retaining its preference for the bulk. Further analysis of oxygen adsorption and the associated electronic structure reveals that the strength of surface–adsorbate binding governs these segregation trends under reactive conditions. The present work offers a theoretical foundation for the rational design of Pd-based alloy catalysts for applications such as the hydrogen evolution reaction. Full article

26 pages, 5344 KB

Open AccessArticle

Longitudinal Repeatome Remodeling in Peripheral Blood Following Parkinson’s Disease Diagnosis

by Jerzy K. Kulski and Sulev Koks

Genes 2026, 17(5), 577; https://doi.org/10.3390/genes17050577 (registering DOI) - 18 May 2026

Abstract

Background/Objectives: Parkinson’s disease (PD) is associated with systemic molecular alterations that extend beyond the central nervous system, including changes in peripheral blood transcriptomic profiles. While prior studies have focused predominantly on coding-gene expression, the longitudinal behavior of the peripheral blood repeatome following clinical diagnosis remains poorly characterized. Here, we investigated temporal remodeling of repetitive-element transcription over 36 months post-diagnosis by integrating repeat subfamily- and locus-specific analyses. Methods: Repeatome expression was quantified using SalmonTE and DESeq2 in peripheral blood RNA-seq data from 1560 PD and control individuals at diagnostic baseline (BL) and four follow-up visits (6, 12, 24, and 36 months). Differential expression was assessed at the subfamily level, with additional locus-specific validation in a representative subset. Results: A total of 259 repeat subfamilies were differentially expressed (padj < 0.05), of which 224 (86.5%) were already detected at baseline. Enrichment of differential expression was significantly higher at baseline than at later visits (odds ratio = 30.9, p < 2.2 × 10⁻¹⁶), with limited additional divergence over time. Longitudinal analyses revealed non-linear trajectories in selected repeat families, including Alu and SVA subfamilies. Locus-specific analysis identified 237 significantly regulated elements, demonstrating heterogeneous, site-specific transcriptional changes, including clusters of differentially expressed loci and instances within PD-relevant genomic regions (e.g., SNCA and IKZF2). Conclusions: Peripheral blood repeatome expression differs between PD and control groups, with the dominant signal established at clinical diagnosis and modest longitudinal modulation thereafter. Integration of locus-level analysis indicates that subfamily level patterns arise from discrete genomic events rather than uniform regulation. These findings support a model of systemic, immune-associated transcriptomic remodeling in circulating blood cells and position the peripheral repeatome as a dynamic framework for biomarker discovery and future mechanistic investigation. Full article

(This article belongs to the Section Genetic Diagnosis)

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18 pages, 4381 KB

Open AccessArticle

MUNILS: A Time-Synchronized and Traffic-Isolated Multi-UAV Simulation Platform Based on Integrated Physical and Network Simulators

by Sangyoon Lee, Geonwoo Yu, Dongwook Lee and Woonghee Lee

Drones 2026, 10(5), 387; https://doi.org/10.3390/drones10050387 - 18 May 2026

Abstract

Recent advancements in Unmanned Aerial Vehicle (UAV) physics simulators, flight control firmware, and network virtualization have been substantial. However, operating these systems independently fails to capture the complex dynamics of real-world multi-UAV networks, thereby compromising simulation reliability. To address this, we propose the Multi-UAV Network-in-the-Loop Simulation (MUNILS) platform, which seamlessly integrates the Gazebo physics engine, the PX4 flight controller, and the ns-3 network simulator via Robot Operating System 2 (ROS2) middleware. Specifically, MUNILS leverages Micro eXtremely Resource Constrained Environments–Data Distribution Service (XRCE-DDS) for high-speed data bridging and employs Linux network namespaces to enforce traffic isolation and routing exclusively through ns-3. Crucially, we introduce a precise cross-layer time synchronization mechanism spanning the physical, control, and network domains to resolve inherent clock discrepancies among these heterogeneous simulators. Experimental evaluations confirm that MUNILS achieves strict traffic isolation, scalable closed-loop flight control, and highly accurate time synchronization across all integrated modules (Gazebo, ns-3, ROS2, and PX4) without cumulative clock drift, thereby providing a highly reliable verification environment for large-scale swarm operations on a single machine. Full article

(This article belongs to the Special Issue Advances in Internet of Drones: Applications, Communication Infrastructures, Architectures, and Protocols for FANETs)

14 pages, 471 KB

Open AccessSystematic Review

Functional Biomechanical Tests of the Foot and Ankle in Physiotherapy and Sports—Outcome Measures, Wearable Sensor Integration, and Psychometric Properties: A Systematic Review

by Guna Semjonova, Rodrigo Vallejo-Martínez, Luis Ceballos-Laita, Sandra Jiménez-del-Barrio, Sergejs Davidovics and Anna Davidovica

J. Clin. Med. 2026, 15(10), 3892; https://doi.org/10.3390/jcm15103892 - 18 May 2026

Abstract

Objectives: To systematically synthesize existing evidence on functional biomechanical tests of the foot and ankle in physiotherapy and sports, focusing on their outcome measures, compatibility with wearable sensor technologies, and psychometric properties. Methods: We performed a systematic review (PRISMA-guided) of PubMed, Web of Science, PEDro, and SPORTDiscus from inception to December 2025. Eligible studies evaluated functional foot/ankle biomechanics in athletes, healthy adults, or adults with musculoskeletal foot/ankle conditions using wearable sensors (e.g., IMUs, wireless pressure insoles). Two reviewers independently screened, extracted data, and appraised methodological quality using the COSMIN Risk of Bias tool, applying property-specific ratings. Heterogeneity precluded meta-analysis; findings were narratively synthesized and tabulated. Results: Twenty full texts were reviewed; four studies (n = 83 participants) met the inclusion criteria. Wearable devices included foot- or trunk-mounted IMUs and wireless pressure insoles. Reported outcomes spanned temporal gait events and inner-stance phases, vertical ground reaction force (vGRF) and centre-of-pressure trajectories, running step rate/stride length, and jump counts in competition. Validity was most frequently assessed: foot-worn IMUs showed millisecond-level agreement with in-shoe pressure references for stance and inner-stance events; pressure insoles demonstrated acceptable agreement with force plates for vGRF/COP alongside fair-to-excellent test–retest reliability; foot- vs. shank-mounted IMUs provided strong agreement for running step rate and stride length; and competition-based jump detection using IMUs achieved high sensitivity. Across studies, reliability indices were inconsistently reported, measurement error (SEM/MDC) was sparse, and MCID was not reported. The COSMIN appraisal ranged from very good/adequate to inadequate, driven primarily by small sample sizes, non-gold-standard comparators, and incomplete psychometric reporting. Full article

(This article belongs to the Special Issue Physiotherapy and Therapeutic Exercise in Modern Clinical Practice)

27 pages, 64664 KB

Open AccessArticle

Behaviour of a Harbour Seal (Phoca vitulina) Mother and Pups in a Zoo Setting

by Susan C. Wilson and William Matthews

Animals 2026, 16(10), 1545; https://doi.org/10.3390/ani16101545 - 18 May 2026

Abstract

Although harbour seals have often bred successfully in captivity, there is little information on the behaviour and welfare of captive mothers and their pups. This study used video of a mother with her newborn pup (P1) during the first 16 days post-partum and further video of the same mother with a second pup (P2) during days 19–22. The most frequent behaviours in the water were body nosing and close body contact. The observations with pup P2 allowed for expanded descriptions of contact and following behaviours in the water. With P1, the mother displayed most responsibility for following and approaching, i.e., for maintaining contact. Suckling usually occurred immediately after the mother led the pup from the water to an onshore suckling location. P1 often rested alone while its mother checked on it continuously from the water and signalled it to return to the water by nudging, nosing and splashing at it. This mother engaged in close contact with both her pups, with both the mother and both pups displaying body language suggestive of positive emotion and, therefore, indicative of good welfare. These observations offer an argument in favour of allowing female harbour seals in captivity to give birth and wean their pups naturally. Full article

(This article belongs to the Special Issue The Behaviour, Needs and Welfare of Pinnipeds in Human Care)

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15 pages, 298 KB

Open AccessArticle

Geometric Characterization of the Numerical Ranges of Generalized Pencils of Pairs of Projections

by Liangyu Fu, Ran Wang and Weiyan Yu

Mathematics 2026, 14(10), 1732; https://doi.org/10.3390/math14101732 - 18 May 2026

Abstract

Let

H

be a complex separable Hilbert space. We study the closure of the numerical range of the generalized pencil

T = P + α Q + β P Q

, where

(P, Q)

is a pair of orthogonal projections [...] Read more.

Let

H

be a complex separable Hilbert space. We study the closure of the numerical range of the generalized pencil

T = P + α Q + β P Q

, where

(P, Q)

is a pair of orthogonal projections and

(α, β) \in R^{2}

. Using Halmos’ two-subspace theorem, it is shown that, under suitable assumptions,

\bar{W (T)}

is the closed convex hull of a family of ellipses

E (λ)

parametrized by

λ \in σ (P Q)

. Moreover, the spectrum

σ (T)

coincides with the set of all foci of this elliptic family, revealing a precise geometric relation between the spectrum and the numerical range of such operators. Full article

16 pages, 4458 KB

Open AccessArticle

Protectiveness of Mn-Co Oxide Coating on Type 430 Stainless Steel for an SOFC Interconnect Application Using an Anodic Electrodeposition Technique

by Jatupong Pantri, Panya Wiman, Thanasak Nilsonthi and Somrerk Chandra-ambhorn

Metals 2026, 16(5), 547; https://doi.org/10.3390/met16050547 (registering DOI) - 18 May 2026

Abstract

Ferritic stainless steels are widely used as interconnects of solid oxide fuel cells (SOFCs) due to their high temperature stability and thermal expansion similar to that of the electrolyte. To help commercialise SOFCs, commercial-grade ferritic stainless steel with a coating, i.e., Type 430, has been considered a promising material for this application. In this work, we developed a Mn-Co oxide coating via anodic electrodeposition followed by heat treatment processes in Ar and oxygen at 800 °C. The proposed coating helped reduce the formation of Cr-rich oxide at the interface between the coating and substrate relative to a sample coated without annealing in Ar. It also provided a relatively dense coating layer and better withstood the applied load, provoking the first spallation of the coating layer assessed by the scratch test. A diagram used to assess the effects of pore density and size on the coating’s protectiveness is included in the manuscript. Full article

(This article belongs to the Special Issue Advances and Challenges in Corrosion of Alloys and Protection Systems)

22 pages, 2686 KB

Open AccessArticle

Integrated Omics Analysis of the Effects of Nano-Antimicrobial Peptide on the Intestinal Microbiota and Metabolome of Tibetan Sheep

by Yaqin Zhao, Xiaoshan Wang, Haixia Jing, Liyuan Zhao and Fengjun Liu

Animals 2026, 16(10), 1543; https://doi.org/10.3390/ani16101543 - 18 May 2026

Abstract

This study investigated the effects of dietary nano-antimicrobial peptides (NAP) on the microbial communities and metabolic profiles in Tibetan sheep. Using 16S rRNA gene high-throughput sequencing and non-targeted metabolomics, the contents of the small intestine, rumen, and rectum were systematically analyzed in a control group (Group A) and a NAP-supplemented group (Group B). Multi-omics integration methods, including O2PLS and Pearson correlation analysis, were employed to explore the association between microbial communities and metabolites. Alpha and beta diversity analyses revealed significant differences (p < 0.05) in the microbial community structure of the small intestine between the two groups. In contrast, the rumen and rectal microbiota remained relatively stable, indicating that the regulatory effects of NAP on the intestinal microecology are site-specific. In the small intestine, NAP altered the composition of dominant functional microbiota and the abundance of taxa related to energy metabolism. Metabolomic analysis identified significant shifts in metabolic profiles, specifically within the bile acid, fatty acid, and phospholipid pathways (p < 0.05). Group A exhibited baseline steady-state characteristics (e.g., cholic acids and phospholipids), whereas Group B showed activation of unsaturated fatty acids and related metabolites. Multi-omics integration revealed a stable systematic association between intestinal microbial genera and metabolites. Specifically, bile acid and prostaglandin metabolites were negatively correlated with Firmicutes-related taxa. These findings suggest that NAP supplementation may contribute to maintaining host energy metabolism and intestinal homeostasis by regulating intestinal microecology. Full article

(This article belongs to the Section Animal Genetics and Genomics)

14 pages, 932 KB

Open AccessArticle

Role of the IRE1α-XBP1 Axis in IgE-Dependent Activation of Mast Cells

by Hiroto Kouda, Kazuki Nagata, Riu Saito and Chiharu Nishiyama

Int. J. Mol. Sci. 2026, 27(10), 4532; https://doi.org/10.3390/ijms27104532 (registering DOI) - 18 May 2026

Abstract

The IRE1α-XBP1 axis is the most conserved of the three major unfolded protein response (UPR) branches triggered by the endoplasmic reticulum (ER) stress. Although the transcription factor XBP1 is involved in the development and function of several hematopoietic lineages, its role in the activation of mast cells (MCs), which are critical in allergic responses, remains largely unknown. We identified salicylaldehyde, which suppresses IRE1α nuclease activity that is essential for XBP1 production, as an inhibitor of MC activation in our previous screening; therefore, we herein investigated the effects of additional IRE1α inhibitors, 3-methyl-6-bromo-salichylaldehyde (MBSA) and KIRA6, targeting the nuclease domain and kinase domain, respectively, on MC activation. MBSA and KIRA6 suppressed IgE-dependent degranulation of bone marrow-derived MCs (BMMCs) but did not inhibit Ca²⁺ ionophore- or compound48/80-induced degranulation. Treatments with inhibitors of two other branches of UPR, the PERK and ATF6 pathways, did not affect the IgE-induced activation of BMMCs. The intraperitoneal administration of MBSA or KIRA6 significantly suppressed IgE-induced passive anaphylaxis in mice. Furthermore, to examine the effects of XBP1, siRNA-mediated knockdown was performed. The results obtained confirmed that Xbp1 siRNA introduction reduced the IgE-dependent degranulation of BMMCs in parallel with the knockdown level of Xbp1 mRNA. Therefore, the IRE1α-XBP1 axis plays a significant role in IgE-dependent and MC-mediated allergic responses and is considered to be a therapeutic target of allergic diseases. Full article

(This article belongs to the Special Issue Molecular Mechanisms of Allergy and Asthma: 4th Edition)

19 pages, 6604 KB

Open AccessArticle

Physicochemical Evolution of Glutinous Rice Flour and Its Influence on Tangyuan Processing Performance

by Fengzhang Wang, Ning Li, Jianing Dou, Enhong Gao and Litao Tong

Foods 2026, 15(10), 1789; https://doi.org/10.3390/foods15101789 - 18 May 2026

Abstract

The quality of glutinous rice flour (GRF) plays a critical role in determining the processing suitability of Tangyuan, a traditional Chinese glutinous rice-based food. This study systematically characterized the physicochemical, pasting, textural and digestive properties of twelve representative GRFs, as well as the cooking behaviors of the resulting product of Tangyuan. The results revealed that different GRFs displayed varied protein, total starch and amylopectin contents. The microstructure of Tangyuan exhibited three main types: robust and dense (e.g., H1 and H3), porous and soft (e.g., S1 and S4), and fragmented and disrupted (e.g., S2 and S3) networks. Rheological and pasting profiling revealed that doughs with extreme rigidity (G′ > 10⁴ Pa) and high setback values exhibited rapid retrogradation, leading to severe frost cracking during cold-chain storage. Tangyuan with moderate G′, loss tangent (tan δ) below 0.35, and balanced peak viscosities provided optimal viscoelasticity for both mechanical machinability and freeze–thaw stability. Furthermore, S5 with naturally high resistant starch contents significantly attenuated the hydrolysis index, successfully shifting Tangyuan from a high-glycemic to a medium-glycemic profile. The results provide valuable insights into the screening of raw glutinous rice flour from different origins, offering theoretical guidance for the standardized production of freeze–thaw-stable and low-glycemic functional Tangyuan. Full article

(This article belongs to the Special Issue Novel Approaches for the Detection of Grain Products' Quality and Adulteration)

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20 pages, 678 KB

Open AccessSystematic Review

The Relationship Between Body Dysmorphic Disorder and Orthodontic Treatment Need: A Systematic Review

by Theoklitos Tsaprazlis, Konstantinos Lappas, Miltiadis A. Makrygiannakis, Heleni Vastardis and Eleftherios G. Kaklamanos

J. Pers. Med. 2026, 16(5), 271; https://doi.org/10.3390/jpm16050271 - 18 May 2026

Abstract

Background: Body Dysmorphic Disorder (BDD) is characterized by an intense preoccupation with perceived flaws in physical appearance, which can influence choices related to aesthetically driven healthcare. In orthodontics, this may cause a mismatch between a person’s subjective concern about their appearance and the treatment need determined by established indices. Therefore, orthodontic treatment indices are crucial to ensure that interventions are clinically justified rather than primarily motivated by disproportionate appearance-related distress. Objective: To systematically review and appraise the existing evidence on the connection between BDD and orthodontic treatment need as assessed by established indices. Materials and Methods: A systematic search of five electronic databases was conducted for studies published up to March 2026 that examined the association between BDD and orthodontic treatment need. Eligible studies included individuals undergoing orthodontic treatment or seeking orthodontic care, in whom BDD was evaluated using validated instruments and treatment need was assessed using established orthodontic indices. Risk of bias was assessed using the ROBINS-E tool. Results: A total of 2743 records were identified, and four observational studies met the inclusion criteria. Due to heterogeneity in study design, assessment methods and outcomes, findings were synthesized narratively. Orthodontic treatment need was assessed using the Dental Health Component of the Index of Orthodontic Treatment Need (IOTN-DHC), the Aesthetic Component of the Index of Orthodontic Treatment Need (IOTN-AC), and the Index of Complexity, Outcome and Need (ICON). Two studies using IOTN-DHC reported a negative association between BDD and orthodontic treatment need, whereas studies using IOTN-AC and ICON found no significant relationship. Associations with sex, age, education, depression, and anxiety were inconsistent across studies. Conclusions: Current evidence suggests an inconsistent relationship between Body Dysmorphic Disorder and orthodontic treatment need, highlighting the relevance of personalized assessment in orthodontic decision-making. Given the limited number of studies and the high risk of bias, the findings should be considered preliminary, and further standardized studies are needed to clarify this association. Full article

(This article belongs to the Special Issue Advances in Oral Health: Innovative and Personalized Approaches)

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