Search Results (44)

(1) Background: Posterior crossbite associated with maxillary transverse deficiency is commonly managed with maxillary expansion, yet the correspondence between laboratory activation behavior and the clinical response of nickel–titanium leaf-spring expanders remains insufficiently defined; therefore, this study aimed to compare in vitro and in vivo performance of the Leaf Expander^® and to assess their agreement. (2) Methods: A retrospective sample of 15 mixed-dentition patients (7–10 years) treated at two university centers with a Leaf Expander^® (6 mm screw; 900 g) was evaluated; interpremolar (E–E), intermolar (6–6), and intercanine (C–C) distances were recorded at baseline (T0, digital models) and at follow-up visits (T1–T5, caliper measurements), while mechanical compression testing (Instron 3365) quantified force release across the activation sequence; normality (Shapiro–Wilk), parametric analyses, and Pearson correlation were used. (3) Results Posterior crossbite correction was achieved in all completed cases, with mean total increases (T0–T5) of 5.4 mm (E–E), 4.4 mm (6–6), and 6.0 mm (C–C); early expansion (T1–T0) averaged 2.5 mm at E–E, and laboratory curves showed an activation peak followed by sustained force release (~6.5–9 N) and a residual-load phase. Agreement between declared activation and clinical response was higher for E–E and 6–6 than for C–C, which showed greater variability. (4) Conclusions: These findings support the Leaf Expander^® as an effective compliance-free slow expansion device and indicate that laboratory force behavior can help interpret the clinical expansion timeline, including delayed expression after activation. Full article

Objective: To determine the publication bias of the reported prevalence of malocclusions in Mexican children and adolescents. Background: Publication bias determination is crucial in a systematic review, helping to ensure the conclusions’ validity and reliability. Nevertheless, without accurate knowledge of disease prevalence and patterns, the health system risks inefficiency, inequity, and failure to meet the population’s needs. On the other hand, malocclusions can impair proper chewing efficiency, contributing to digestive alterations, and nutritional deficiencies among other functional, psychological, and social problems. The data of the prevalence of malocclusion is imperative to implement early interventions in health services that prevent more severe skeletal discrepancies and reduce the need for invasive treatments in adolescence or adulthood. Methods: Studies were collected from five databases, following the PRISMA and Cochrane guidelines for systematic reviews. Eligibility criteria were full-text research in which the prevalence of malocclusions was reported. The risk of bias (Hoy tool), publication bias (the Doi plot and the Luis Furuya-Kanamori (LFK) index), and quality assessments (GRADE tool) were performed. The data were combined using a random-effects meta-analysis. Results: The result of the meta-analysis suggests a high prevalence of malocclusions in mixed dentition was 50.2% (95% confidence interval [CI]: 38.9–61.5%). However, the studies showed a risk of bias and publication bias. Conclusions: In Mexico, there is a high prevalence of malocclusions among children and adolescents. However, these results are not robust enough to draw solid conclusions, due to the low certainty of the evidence. Full article

Early detection of dental caries in children is critical to prevent irreversible tooth damage and guarantee optimal oral health outcomes. However, interpreting pediatric panoramic radiographs throughout the mixed dentition stage remains a very challenging task due to overlap in anatomical structures and developmental variability. This complexity underscores the need for well curated, representative datasets that enable the development of reliable computer-aided diagnostic models. Herein, this study introduces the Mixed Dentition Orthopantomogram Dataset, a newly developed, publicly available dataset of children that was carefully labeled by dental specialists to identify proximal and occlusal caries regions in the range of 3–12 years. To evaluate the dataset’s applicability for artificial intelligence research, we benchmarked it using both classification and segmentation models. A patch-based classifier achieved an average AUC of 0.89 and Recall 0.85 in distinguishing healthy and carious regions. For segmentation, we evaluated U-Net and Attention U-Net with multiple loss functions, and the Attention U-Net trained with Focal loss achieved the best Dice score of 0.94. Collectively, these findings support the dataset’s utility for pediatric caries analysis and demonstrate the viability of deep learning approaches for mixed dentition panoramic imaging. Full article

Objectives: This study aimed to investigate preventive management strategies and optimal intervention timing for dental ankylosis of primary teeth complicated by suspected pre-eruptive intracoronal resorption (PEIR), providing an evidence-based framework for clinical diagnosis and management. Methods: This case retrospectively reports a 7-year-old patient with an ankylosed mandibular left second primary molar (tooth 75), exhibiting radiographic features suggestive of pre-eruptive intracoronal resorption. The patient was in the mixed dentition stage with dental crowding. Preventive and interceptive orthodontic management was implemented to address space deficiency and guide occlusal development. The timing of extraction and space maintenance of tooth 75 was guided by space regaining, PEIR lesion progression, and crown development of tooth 35. Results: The permanent successor of tooth 75 (tooth 35) erupted successfully, dental crowding was alleviated, and a favorable occlusion was established. Conclusions: Early diagnosis and timely, individualized intervention for ankylosed primary teeth play an important role in preventing malocclusion and promoting normal eruption of the permanent successor tooth. Full article

Objectives: This study evaluated the accuracy of an artificial intelligence (AI)-based cephalometric software (WebCeph version 2.0.0.) compared with manual tracing and determined whether stratifying patients by chronological age or dentition stage provides a more clinically relevant assessment of AI accuracy. Methods: Three hundred lateral cephalometric radiographs of Vietnamese patients were traced manually by an orthodontist (reference standard) and analyzed automatically by WebCeph. Intra-observer reliability was validated using ICC and Dahlberg’s error. We analyzed the data using three stratification strategies: (1) Overall; (2) Chronological age (<18, 18–25, >25 years); and (3) Dentition stage (<9 primary-early mixed, 9–12 late mixed, >12 permanent). The primary outcome was the absolute measurement difference (∣Δ∣), analyzed using the Kruskal–Wallis test and effect size (${\eta }^2$). Results: Overall, WebCeph showed high concordance with manual tracing (ICC > 0.80 for most parameters). Chronological age stratification showed weak associations with measurement error; differences between groups were largely non-significant ($p>0.05$) with a small effect size (${\eta }^2\approx 0.015$). In contrast, the dentition stage revealed significant performance disparities ($p<0.05$). Notably, accuracy for the Mandibular Arc (ICC = 0.349) and Mandibular Plane Angle ($p=0.048$) degraded significantly in the primary-early mixed group, a vulnerability obscured by chronological age-based stratification. Conclusions: Dentition stage is a more sensitive and biologically relevant predictor of AI accuracy than chronological age. While WebCeph is reliable for permanent dentition, accuracy degrades significantly in the primary-early mixed phase. Clinicians should prioritize manual verification of mandibular and incisor landmarks in mixed-dentition children. Full article

Background: This study assessed the long-term stability of dental arch changes achieved through clear aligner treatment in growing patients during the early mixed dentition stage. Methods: This retrospective study included 20 patients (mean age 8.3 ± 0.4 years) treated with clear aligners according to a standardized sequential expansion protocol. No additional auxiliaries, interproximal reductions, or retentions were used. Dental casts were collected at baseline (T0), end of treatment (T1), and two years post-treatment without retention (T2). Linear and angular measurements (arch width, molar and incisor torque, Henry’s angle, overjet, overbite, and Little’s index) were assessed on digital models. Friedman ANOVA and Wilcoxon signed-rank tests were applied (α = 0.05). Results: At T1-T0, significant transversal expansion was achieved in both arches (U6–6 mesial +2.1 mm; L6–6 mesial +2.4 mm; p < 0.05), with favorable torque changes and a reduction in overjet (−1.5 mm). From T1 to T2, only minimal, non-significant relapse was detected, except for a slight reduction in lower left molar torque (−1.1°). The T2-T0 comparison confirmed stable improvements in mesial intermolar widths (upper +2.0 mm; lower +1.6 mm), molar derotations, and overjets (−1.9 mm), with no significant loss of expansion or sagittal correction. Conclusions: Clear aligners in early mixed dentition achieved significant and stable dental arch modifications over a 2-year follow-up without the use of retention appliances. This therapeutic approach may represent a reliable interceptive option in growing patients. Full article

Background/Objectives: The optimal timing for orthodontic treatment in pediatric patients with malocclusion, particularly Class II discrepancies, remains a topic of ongoing clinical debate. Early treatment during the mixed dentition stage harnesses craniofacial growth potential, whereas later intervention may capitalize on pubertal growth for greater skeletal correction, especially for skeletal and airway improvements. This systematic review aimed to compare the outcomes of early versus late orthodontic treatment to assess their relative effectiveness. Methods: A systematic review was conducted in accordance with PRISMA guidelines, including randomized controlled trials and observational studies published between 2015 and 2025. Eleven studies comparing early and late treatment were analyzed, and the risk of bias was evaluated using standardized assessment tools. Results: Of the eleven studies, eight reported statistically significant improvements favoring early orthodontic intervention. Early treatment was associated with greater enhancement of maxillary and mandibular arch development, improved jaw relationships, and expanded airway dimensions. Studies utilizing headgear or other growth-modifying appliances also showed more favorable eruption patterns and alignment, underscoring the clinical relevance of early-phase management. Conclusions: Early orthodontic treatment can provide meaningful benefits in guiding skeletal growth, improving dental arch form, and enhancing treatment efficiency. These benefits were most consistently supported in skeletal and airway outcome domains. While late treatment may be suitable for some cases, personalized planning remains essential. Further large-scale, standardized longitudinal studies are needed to refine treatment-timing protocols in pediatric orthodontics. Full article

Objectives: Dental eruption is a complex process influenced by various factors, including endocrine factors as growth hormone (GH). The aim of this study was to assess differences in the advancement of tooth eruption between growth hormone-deficient (GHD) and idiopathic short-statured (ISS) children and a control group of children with normal growth patterns. Methods: A total of 156 children participated in this study: 78 patients with short stature (50 boys and 28 girls) and 78 healthy and age- and sex-matched control subjects. Each permanent tooth was classified according to its clinical eruption stage by one trained and calibrated dentist. Results: The mean age was 10.22 ± 2.42 years for the study and 10.15 ± 2.45 for the control group. In our study, we observed eruption delay during the early mixed dentition stage. A significant difference was found in the degree of eruption for all incisors and first permanent molars between the GHD before treatment group and the control group (p = 0.045). The difference was apparent at the initial stage of permanent tooth eruption, in the group of children who had not yet initiated growth hormone treatment. The eruption of remaining tooth groups did not differ significantly between the children with growth failure and the control group (p > 0.05). Conclusions: Our findings indicate that the delay in tooth eruption observed in short-statured children, particularly affecting the first permanent molars and incisors, may reflect the direct influence of growth hormone deficiency on early dental development. The clinical relevance of this finding underlines the importance of individualized dental care and careful timing of orthodontic assessments in short-statured patients, especially prior to the initiation of GH therapy. Full article

Background/Objectives: Accurate identification of deciduous and permanent teeth on panoramic radiographs (PRs) during mixed dentition is fundamental for early detection of eruption disturbances, yet relies heavily on clinician experience due to developmental variability. This study aimed to develop a deep learning model for automated tooth detection and segmentation in pediatric PRs during mixed dentition. Methods: A retrospective dataset of 250 panoramic radiographs from patients aged 6–13 years was analyzed. A customized YOLOv11-based model was developed using a novel hybrid pre-annotation strategy leveraging transfer learning from 650 publicly available adult radiographs, followed by expert manual refinement. Performance evaluation utilized mean average precision (mAP), F1-score, precision, and recall metrics. Results: The model demonstrated robust performance with mAP_0.5 = 0.963 [95%CI: 0.944–0.983] and macro-averaged F1-score = 0.953 [95%CI: 0.922–0.965] for detection. Segmentation achieved mAP_0.5 = 0.890 [95%CI: 0.857–0.923]. Stratified analysis revealed excellent performance for permanent teeth (F1 = 0.977) and clinically acceptable accuracy for deciduous teeth (F1 = 0.884). Conclusions: The automated system achieved near-expert accuracy in detecting and segmenting teeth during mixed dentition using an innovative transfer learning approach. This framework establishes reliable infrastructure for AI-assisted diagnostic applications targeting eruption or developmental anomalies, potentially facilitating earlier detection while reducing clinician-dependent variability in mixed dentition evaluation. Full article

Background/Objectives: Vascular Malformation—Osteolytic Subtype (VMOS) is an exceptionally rare autosomal recessive disorder caused by homozygous pathogenic variants in the ELMO2 gene, with fewer than ten genetically confirmed pediatric cases reported worldwide. This report presents the longitudinal dental management and clinical course of a child with VMOS, emphasizing the challenges of preventive and restorative care in such cases. Methods: A four-year-old child with a confirmed diagnosis of VMOS and a history of urgent bilateral coil embolization and surgical excision of mandibular aneurysmal bone cysts presented for dental care. The patient was followed for three years (2022–2025). Management focused on staged oral rehabilitation, preventive strategies, and restorative interventions adapted to changes across dentition stages. Results: At initial presentation, the child exhibited mandibular swelling, gingival hypertrophy, and a history of spontaneous intraoral bleeding. The postoperative course had been complicated by cerebral abscesses requiring prolonged intravenous antibiotics. During the primary dentition stage, full oral rehabilitation and strict preventive protocols were implemented to minimize caries and infection risk. In the mixed dentition period, the permanent incisors and molars erupted with enamel hypoplasia and developmental defects, necessitating composite restorations. Ectopic eruption and suboptimal oral hygiene, partly related to parental fear of bleeding, were also managed with reinforced preventive counseling. Conclusions: This case highlights the long-term dental implications of VMOS, underscoring the crucial role of the pediatric dentist in early preventive planning and individualized restorative management. Effective multidisciplinary coordination remains essential to preserve oral health and minimize complications in rare vascular syndromes with craniofacial involvement. Full article

Background and Objectives: Early orthodontic intervention during the mixed dentition phase is commonly used to intercept developing malocclusions and potentially reduce the need for more complex treatment later. However, there is limited and conflicting evidence regarding the long-term stability of such early interventions, particularly in comparison to delayed treatment or no treatment at all. This systematic review aims to address this gap by critically evaluating and synthesizing the available evidence on the long-term skeletal and dental outcomes, following early orthodontic treatment in children aged 6–12 years versus delayed or no intervention. Materials and Methods: A comprehensive literature search was conducted across electronic databases (PubMed, Scopus, Web of Science, and Google Scholar) for studies published between January 1995 and April 2025. Eligible studies included randomized controlled trials, controlled clinical trials, and cohort studies involving children who underwent early orthodontic treatment using fixed or removable appliances with a minimum of one-year post-treatment follow-up. Comparator groups included no treatment or delayed treatment. Primary outcomes were long-term changes in overjet, ANB angle, and Peer Assessment Rating (PAR) scores. Meta-analyses were performed using a random-effects model, and the certainty of evidence was assessed using the GRADE framework. Results: A total of 18 studies were included in the systematic review, of which nine provided sufficient data on overjet for meta-analysis, with overlapping datasets available for ANB angle (n = 6) and PAR scores (n = 4). Meta-analyses showed no statistically significant long-term differences between early treatment and control groups in overjet, ANB angle, or PAR scores. Heterogeneity across outcomes ranged from low to moderate. The overall certainty of the evidence was rated as moderate, mainly due to imprecision and variability in study methods. Conclusions: Early orthodontic treatment provides short-term improvements in occlusal and skeletal parameters. However, current evidence does not support consistent long-term benefits over delayed intervention. Clinical decision-making should be individualized and reserved for cases with specific indications, such as functional crossbites, increased risk of dental trauma, or psychosocial concerns. Full article

Background: Supplemental teeth are a rare subtype of supernumerary elements that closely resemble the morphology of normal dentition. Their occurrence in the mandibular anterior region is extremely uncommon. Aim: To describe the clinical features, diagnosis, and phased orthodontic management of a rare case involving bilateral supplemental mandibular incisors in a pediatric patient. Case report: A 7-year-old female patient presented with early mixed dentition and significant lower anterior crowding due to the presence of two fully erupted supplemental mandibular incisors. Treatment phase I included extraction of the malpositioned supplemental teeth and rapid maxillary expansion to transversally coordinate the arches. By the end of phase I, spontaneous alignment of the remaining lower incisors was observed. Discussion: The presence of two supplemental mandibular incisors is extremely rare in Caucasian populations. Supernumerary teeth can cause crowding, impaction, or delayed eruption of adjacent permanent teeth. Timely extraction can prevent such complications and often allows spontaneous alignment. Conclusions: The prompt removal of supplemental mandibular incisors, when they have just erupted, might lead to the alignment of the other incisors, considering that they spontaneously occupy the extractive spaces often without the aid of fixed appliances first line. Full article

Background/Objectives: This retrospective observational study evaluated associations among dentition type, age, systemic conditions, and oral pathology in pediatric patients. Methods: A six-month retrospective analysis was conducted in a specialized pediatric hospital. Patients (n = 155; 0–18 years) were grouped as clinically healthy with oro-maxillofacial diseases or with systemic diseases. Data included dental/periodontal status, anomalies, gingival bleeding index, IOTN score and oral mucosal conditions. Statistical tests (chi-square, ANOVA, and correlations) were applied. Results: Chronic gingivitis was most frequently associated with primary dentition. Caries and root debris were more frequent in ages 4–6, while acute gingivitis appeared in younger children. Orthodontic treatment need increased with age, especially in mixed dentition. Periodontal diseases were most often linked to digestive pathologies. Conclusions: Oral health in children showed associations with age, dentition type, and systemic conditions. Findings highlight associations rather than causation, underscoring the importance of prevention, early monitoring, and age-appropriate interdisciplinary management. Full article

Background/Objectives: Impacted teeth are characterized by having more than three-quarters of root development completed, however failing to erupt or demonstrate imminent eruption, as evidenced both by clinical and radiographic evaluation. Canine impaction is an entity of clinical significance considering its potential to affect both oral function and facial aesthetics. If not appropriately managed, this condition may adversely impact functional occlusion and structural smile integrity. The purpose of the study was to investigate the prevalence of impacted and transmigrant canines in a Greek orthodontic cohort and identify potential sex-based differences. Methods: A total of 2594 panoramic radiographs and clinical records of consecutive patients in the mixed and permanent dentition stages, treated at the Department of Orthodontics of the Aristotle University of Thessaloniki, Greece, were retrospectively retrieved and analyzed to detect the presence of impacted and transmigrant canines. Patients lacking complete clinical records or panoramic radiograph, undergoing or had undergone orthodontic treatment, or presenting conditions affecting normal permanent dentition development, including pathological conditions, cleft lip and palate or hereditary disorders, were excluded. Results: At least one impacted canine was detected in 109 patients (67% females, 33% males), with a median age of 15 years (IQR: 13–18), documenting a 4.2% prevalence (6.97% females, 2.32% males). The frequency of maxillary canine impaction was 3.97%, while in the mandible a frequency of 0.46% was reported. The frequency of bilateral canine impaction was 1%, with it being present in 25.7% of patients with canine impaction. The prevalence of transmigrant canines was 0.11%, with detection solely in the mandible. A statistically significant sex difference was detected solely in the prevalence of impaction. Conclusions: Considering the implications of canine impaction, the epidemiological investigation of this entity may facilitate an early diagnosis and treatment. Full article

Objective: Mandibular expansion remains controversial due to concerns about long-term stability and effectiveness. While maxillary expansion protocols are well established, investigations into mandibular expansion remain limited. This study evaluates the efficacy of the Clara Expander appliance for mandibular expansion in early mixed dentition, assessing skeletal and dental changes using cone-beam computed tomography (CBCT). Materials and Methods: This prospective longitudinal study was conducted in Valencia, Spain, with a population of healthy children aged 6–10 years presenting negative osseodental mandibular discrepancies. CBCT scans were performed before and after treatment to evaluate mandibular dimensional changes, with statistical analyses conducted and a significance threshold of p < 0.05. A total of seven subjects were included in this case series, allowing for a descriptive analysis of treatment outcomes within this specific clinical context. Results: CBCT analysis confirmed significant mandibular expansion following the Clara Expander protocol. Post-treatment findings showed statistically significant increases in dental parameters, including Tooth 6 (furcation, MD = −2.25; p = 0.015), Tooth E (furcation, cementoenamel junction, vestibular, lingual, all p < 0.001), Tooth D (all variables significant), and Tooth C (furcation, MD = −4.18; p = 0.002; cementoenamel junction, MD = −3.56; p = 0.015). Conclusions: The Clara Expander appliance effectively promotes skeletal and dental mandibular expansion, with minimal adverse effects. Its user-friendly, non-invasive design enhances patient compliance and outcomes, contributing valuable data to the field of mandibular expansion and informing future research and clinical applications. Full article