Search Results (74)

Background: Obstructive sleep apnea (OSA) is a prevalent disorder in both pediatric and adult populations, characterized by substantial morbidity encompassing cardiovascular, neurocognitive, and metabolic impairments. Management strategies vary by age group and underlying etiology, with orthodontic and non-orthodontic interventions playing key roles. This narrative review synthesizes the current evidence on orthodontic and non-orthodontic therapies for OSA in pediatric and adult populations, emphasizing individualized, multidisciplinary care approaches and highlighting future research directions. Methods: A narrative review was conducted using PubMed, Scopus, and Google Scholar to identify studies on diagnosis and management of OSA in children and adults from 2000 to 2025. Results: In pediatric patients, treatments such as rapid maxillary expansion (RME), mandibular advancement devices (MADs), and adenotonsillectomy have shown promising outcomes in improving airway dimensions and reducing apnea–hypopnea index (AHI). For adults, comprehensive management includes positive airway pressure (PAP) therapy, oral appliances, maxillomandibular advancement (MMA) surgery, and emerging modalities such as hypoglossal nerve stimulation. Special attention is given to long-term treatment outcomes, adherence challenges, and multidisciplinary approaches. Conclusions: The findings highlight the need for individualized therapy based on anatomical, functional, and compliance-related factors. As the understanding of OSA pathophysiology evolves, orthodontic and adjunctive therapies continue to expand their role in achieving durable and patient-centered outcomes in sleep apnea management. Full article

Objectives: This study aimed to evaluate the effects of AMCOP^® elastodontic appliances on cephalometric parameters of skeletal divergence and upper airway dimensions in growing patients, comparing treated individuals with an untreated control group. Methods: A total of 60 subjects (30 treated with AMCOP^® devices and 30 controls) were selected, with mean ages of 8.67 ± 1.3 and 9.19 ± 0.8 years, respectively. The AMCOP^® appliances, designed for mixed dentition, were worn for 1 h during the day and throughout the night for 6–8 months. Cephalometric analyses were conducted at the beginning (T0) and end (T1) of treatment. Statistical analyses were performed using multivariable linear regression models to assess changes in skeletal and airway parameters, with significance set at p < 0.05. Results: Significant reductions were observed in Ans-Snp^Go-Gn (p = 0.0351), SN^Go-Gn (p = 0.0091), and FMA (p < 0.001) in the treated group compared to controls, indicating improved mandibular rotation. Upper airway spaces (SPAS, MAS, IAS) increased significantly, suggesting enhanced airway patency. Regression models confirmed the positive impact of AMCOP^® therapy on skeletal and airway outcomes, particularly in subjects with pronounced vertical discrepancies. Conclusions: AMCOP^® elastodontic devices effectively promote anterior mandibular rotation and reduce mandibular plane inclination in hyperdivergent patients, contributing to balanced craniofacial growth. The expansion of pharyngeal spaces indicates potential respiratory benefits. Future research is needed to confirm long-term stability and address variability in treatment response. Full article

This study aimed to assess skeletal and upper airway modifications induced by the Twin Block appliance in patients with Class II malocclusion due to mandibular retrusion, using two-dimensional imaging techniques. A total of 11 patients (6 males, 5 females) were included and stratified into two groups (Pre-Peak and Peak) based on skeletal maturity evaluated through the cervical vertebral maturation (CVM) method. Lateral cephalometric radiographs were obtained at the beginning (T0) and end (T1) of treatment and analyzed using DeltaDent software. The appliance was worn full-time, except during meals and oral hygiene procedures, with monthly follow-ups. Significant changes were observed between T0 and T1 across the sample. Comparison between groups revealed statistically significant differences only in the H-C3a1 and vertical height (th) parameters (p < 0.05). In conclusion, the Twin Block appliance proved effective in enhancing mandibular and dental positioning, while also exerting a favorable influence on upper airway development. Full article

Background and Objectives: Orthodontic treatment, whether fixed or removable, offers several benefits, including improved aesthetics, enhanced oral function, and increased self-confidence. However, it may also cause discomfort and pain, particularly following adjustment visits. This study aimed to assess pain characteristics (latency and continuity), food impairment, weight loss, and analgesic use in relation to treatment duration and appliance type. Methods: This observational study included 160 orthodontic patients who completed a structured questionnaire comprising 13 single-choice items. The questionnaire assessed age, gender, residential environment, educational status, type and duration of orthodontic treatment, pain characteristics (duration, latency, continuity), food impairment, and analgesic use. Inclusion criteria specified patients with moderate anterior crowding undergoing fixed orthodontic treatment or treatment with clear aligners on both arches, for at least one month. All fixed appliance cases involved 0.022-inch-slot Roth prescription brackets. Results: Patients undergoing fixed orthodontic treatment reported a higher frequency of pain (91.4%), greater need for analgesics (95.2%), and more food impairment compared to those with clear aligners. Patients treated for less than 6 months more frequently reported pain lasting 1 week (57.1%), while those treated for 1–2 years more commonly reported pain lasting several days (43.8%). Conclusions: Fixed orthodontic appliances are associated with greater discomfort, longer pain latency, more frequent analgesic use, and higher dietary impact compared to clear aligners. These findings emphasize the importance of personalized patient counseling and proactive pain management to improve compliance, enhance quality of life, and support informed decision-making in orthodontic care. Full article

Background: Surface electromyography (sEMG) enables the non-invasive assessment of muscle activity and is widely used in orthodontics for evaluating masticatory muscles. However, little is known about the dynamic changes in facial expression muscles during orthodontic treatment. This study aimed to investigate alterations in facial muscle tone during the leveling and alignment phase in adult female patients undergoing fixed appliance therapy. Methods: The study included 30 female patients aged 20–31 years who underwent sEMG assessment at four time points: before treatment initiation (T0), at the start of appliance placement (T1), three months into treatment (T2), and six months into treatment (T3). Muscle activity was recorded during four standardized facial expressions: eye closure, nasal strain, broad smile, and lip protrusion. Electrodes were placed on the orbicularis oris, orbicularis oculi, zygomaticus major, and levator labii superioris alaeque nasi muscles. A total of 1440 measurements were analyzed using Friedman and Conover-Inman tests (α = 0.05). Results: Significant changes in muscle tone were observed during treatment. During lip protrusion, the orbicularis oris and zygomaticus major showed significant increases in peak and minimum activity (p < 0.01). Eye closure was associated with altered orbicularis oris activation bilaterally at T3 (p < 0.01). Nasal strain induced significant changes in zygomaticus and levator labii muscle tone, particularly on the right side (p < 0.05). No significant changes were noted during broad smiling. Conclusions: Orthodontic leveling and alignment influence the activity of selected facial expression muscles, demonstrating a dynamic neuromuscular adaptation during treatment. These findings highlight the importance of considering soft tissue responses in orthodontic biomechanics and suggest potential implications for facial esthetics and muscle function monitoring. Full article

This study aimed to evaluate the impact of Twin Block appliance therapy on skeletal, dentoalveolar, and facial soft tissue characteristics. The study included 18 participants with Class II skeletal malocclusion who were treated with the Twin Block appliance. Lateral cephalograms and 3D face scans were analyzed before and after therapy for each participant. Dependent t-test results showed a significant increase in the protrusion of the lower incisors (p < 0.001), proclination of the lower incisors (p = 0.021), SNB (p = 0.005), Ls:E (p = 0.040), mandibular length (p < 0.001), and soft tissue mandible length (p < 0.001) and a significant decrease in the ANB (p = 0.003), Wits (p = 0.001), ANPG (p = 0.001), overbite (p = 0.001), and the retrusion of upper incisors (p = 0.002). Twin Block therapy caused changes in skeletal and soft tissue characteristics. The increase in the SNB angle and mandibular length, accompanied by the decrease in the ANB and Wits values reduced the skeletal discrepancy. The reduction in the ANPG indicated an improvement in the skeletal profile. Additionally, the increase in the soft tissue mandible length and distance between the upper lip and E-line contributed to improved esthetic soft tissue profile characteristics. Full article

Objectives: This study investigated the use of artificial intelligence (AI) in the design of lingual bracket indirect bonding trays and its association with bracket transfer accuracy using three-dimensional (3D) printing. Methods: Digital impressions of patient’s dental arches were captured using an intraoral scanner, and orthodontic setups were virtually constructed. Brackets were virtually positioned in their ideal locations using the digital setups guided by virtual archwire templates. Indirect bonding trays were automatically generated using the AI-powered Auto Creation function of the Medit Splints application, which analyzes anatomical features to streamline design. Bracket transfer accuracy was evaluated in vivo by comparing planned and actual bracket positions across grouped and individual tray configurations. Linear and angular deviations were measured using conventional 3D inspection software. Results: Most bracket transfer errors were within clinically acceptable thresholds, although torque accuracy remained suboptimal. Grouped trays generally exhibited greater precision than individual trays in several dimensions. Conclusions: These findings support the application of AI-assisted design tools to enhance digital workflows and improve consistency in appliance fabrication. Full article

Background/Objectives: Orthodontic camouflage is a treatment strategy designed to address mild to moderate skeletal discrepancies through dental compensation when growth modification or orthognathic surgery (OGS) is unsuitable or declined by the patient. This report highlights the treatment of a child with a skeletal Class II pattern, Class II division 1 malocclusion, a 10.8 mm overjet, traumatic overbite, and unilateral temporomandibular joint (TMJ) ankylosis on the left side. Methods: The treatment plan focused on correcting the proclination of the maxillary incisors and improving the facial profile. A non-extraction camouflage approach using pre-adjusted edgewise appliances was implemented following a gap arthroplasty procedure on the left TMJ. Results: The patient achieved a satisfactory treatment outcome, with an ideal static and functional occlusion and significant improvement in facial esthetics. The approach effectively managed the severe mandibular retrognathia and TMJ ankylosis without OGS, thereby minimizing the risk of progressive condylar resorption. Conclusions: This case underscores the importance of personalized treatment plans tailored to each patient’s dental, skeletal, and individual needs. It demonstrates that non-surgical camouflage treatments can be a viable alternative for addressing severe mandibular retrognathia with TMJ ankylosis, achieving favorable esthetic and functional outcomes. Full article

Background: A transverse discrepancy refers to a dimensional difference in the transverse component of the upper and lower dental arches with functional and esthetic implications. The main purpose of this study is to compare the effectiveness of transverse expansion movement of dentoalveolar nature performed by two innovative orthodontic appliances: elastodontic devices and clear aligners. Specifically, it is intended to determine which of the two methods is more effective in terms of dentoalveolar expansion in a sample of children with mixed dentition. Methods: In total, 29 patients aged 6 to 13 years with mixed dentition were included in the present study and divided into two groups according to a case–control scheme. Of the subjects, 15 (8 females and 7 males) represented the test group and were treated with Eptamed elastodontic devices, while the control group, consisting of 14 patients (12 females and 2 males), received a Spark aligner. The efficacy of the devices was evaluated by comparing cross-sectional measurements of the arch scans at time T0 (before the start of treatment), T1 (6 months after the start of treatment) and T2 (one year after the start of treatment) by measurement in mm of the distance between the palatal cusps of the first upper premolar (if missing, of the corresponding deciduous molar). Statistical analysis was conducted using a nonparametric approach with the Wilcoxon signed-rank test. Statistical significance was set at p < 0.05. The data resulting from the measurements were expressed as the mean (standard deviation). Results: No statistically significant difference was observed between the two groups at either T0 (p = 0.3), T1 (p = 0.78), or T2 (p = 0.66), thus allowing the conclusion that both treatment modalities are comparable. Conclusions: Both elastodontics and clear aligners proved to be effective devices in the treatment of transverse discrepancies of a dentoalveolar nature. Elastodontics also plays a crucial role in the rebalancing of stomatognathic and extrastomatognathic functions. Full article

Aim: Class II Division I malocclusion poses significant challenges in orthodontics. The combination of a Herbst appliance and miniscrew anchorage emerged as a practical solution to improve skeletal and dental outcomes. This study employed finite element analysis to evaluate the biomechanical effects of a miniscrew-supported Herbst appliance on mandibular advancement and dentition movement. Methods: High-definition CBCT scans captured the maxilla and mandible’s detailed dental anatomy. The scans were stored in DICOM format for seamless integration with Mimics software (Mimics Innovation Suite research version 21.0, Materialise NV, Leuven, Belgium) for 3D reconstruction and model refinement. The appliance, designed with a maxillary fixed palatal arch and mandibular acrylic splint connected by telescoping rods, incorporated titanium TADs and elastic chains. STL models were optimized in Geomagic x Design for finite element analysis in Abaqus, assigning validated mechanical properties for materials. Tetrahedral meshing and realistic boundary conditions simulated biomechanical interactions. Tetrahedral C3D4 elements were used for meshing, ensuring a balance between computational efficiency and detailed anatomical representation. Tetrahedral meshing and realistic boundary conditions simulated biomechanical interactions. Dynamic simulations in CATIA evaluated mandibular movement. FEA analyzed displacement across dentoalveolar structures along the X, Y, and Z axes to assess treatment efficacy and biomechanical stability. Results: The Z displacement analysis revealed that the incisal edges of the lower central, lateral, and canines shifted lingually by 0.41, 0.4, and 0.47 mm, respectively. Additionally, the apices of the lower central, lateral, and canines displaced backwards by 0.05 mm, 0.05 mm, and 0.07 mm, respectively. Conclusions: The appliance facilitated mandibular advancement, bodily retracted the lower incisors, well-controlled the upper ones, and mesial-tipped the upper posterior teeth. In contrast with traditional functional appliances, it caused the lower anterior teeth to move backwards, while skeletal anchorage overcame some shortcomings of nonsurgical treatments. This method might be a good treatment option for growing skeletal Class II patients. Full article

Background: This retrospective study aimed to analyze the frequency and extent of apical root resorptions (EARR) during orthodontic treatment in the upper and lower incisors, as well as lower molars, using orthopantomograms (OPG). Potential influencing factors such as age, gender, root shape, type of orthodontic appliance, and treatment duration were examined as well. Methods: A total of 57 patients who completed their treatment at the orthodontic department of the Goethe University of Frankfurt between 2011 and 2018 were included in the study. These patients had a combined total of 570 teeth, which were divided into two groups. Group 1 consisted of 20 patients (average age at T0: 10.1 ± 1.2 years old) received a one-phase fixed orthodontic treatment using passive self-ligating Damon bracket system (average duration of 2.1 years ± 6 months), while group 2 consisted of 37 patients (average age at T0: 12.4 ± 2.8 years old) underwent a two-phase therapy, which involved a phase-one functional therapy (average duration of 1.7 years ± 6 months) prior to the phase-two fixed orthodontic treatment with the Damon system (average duration of 1.5 ± 4 months) with a total treatment time of 3.2 years ± 7 months. To determine the extent of post-treatment root resorption of the upper and lower incisors, as well as the first lower molars, crown–root ratio was calculated for each tooth using the pre- and post-treatment OPGs. Additionally, each tooth was assigned a degree of resorption according to the Levander and Malmgren classification. The inter-group comparisons were conducted using the Wilcoxon Mann–Whitney U test. Spearman’s correlation analysis was used to assess the relationship between age, treatment duration, and EARR. The association between gender, root morphology, and EARR was evaluated using the Wilcoxon Mann–Whitney U test. For nominally scaled variables, the Chi-square test was used. The statistical significance was set at p < 0.05. Results: No statistically significant differences were seen between groups 1 and 2 regarding the degree of root resorption (p = 0.89). The study found that the average root resorption for all examined teeth was −5.14%, indicating a slight reduction in the length of the tooth roots after orthodontic treatment. However, no significant differences were observed concerning gender, age, type of orthodontic appliance or treatment duration. Comparisons between upper and lower jaws also did not yield statistically significant differences. The majority of teeth in the study exhibited a normal root shape. The short root length and a pipette formed roots were significantly associated with a higher risk of root resorption (p = 0.001). Conclusions: The study’s findings suggest that the two-phase orthodontic treatment does not increase the risk of EARR compared to one-phase therapy significantly. Some degree of root resorption occurred as a result of orthodontic treatment in both groups. Notably, abnormal root forms were identified as influential factors that could help predict the likelihood of root resorption following orthodontic treatment. Full article

Excessive mandibular growth is largely affected by genetic factors and its orthodontic management is challenging. The present study utilized histophotometry and aimed to investigate immunohistochemical alterations in rat condyles following posterior mandibular displacement using a fixed intraoral functional appliance. Seventy-two male Wistar rats were divided into two equal groups, experimental and control, each consisting of three equal subgroups. The animals were sacrificed after 30, 60, and 90 days, and their condyles were isolated and examined microscopically for potential immunohistochemical changes. Statistically significant differences in RANKL appeared at days 30 and 60, while noteworthy changes regarding TRAP were evidenced at days 30 and 90. In the experimental group, RANKL decreased statistically significantly between days 60 and 90, while in the control group, the RANKL measured significantly increased at day 90 compared to days 30 and 60 alike. In the experimental group, TRAP appeared significantly decreased at day 60 vs. 30, while at day 90 vs. 60, it was found to be significantly increased. In the control group, there were no significant changes in TRAP. Posterior mandibular displacement may cause immunohistochemical changes in the rat condylar bone, and such outcomes should be considered when planning similar procedures in humans. Full article

Background: Canines play a vital functional and aesthetic role in human dentition, yet impacted canines, particularly in the mandible, are rare and can lead to functional disorders, such as the absence of canine guidance, while negatively affecting a patient’s self-esteem. Transmigration of mandibular canines adds complexity to treatment. One method to reduce the treatment time, especially for impacted teeth, is corticotomy-assisted orthodontic therapy (CAOT). Methods: A 13-year-old patient presented with a horizontally impacted lower right canine, positioned below the roots of the lower incisors, showing transmigration. A digitally designed and 3D-printed lingual appliance was attached to the lower molars with hooks on the lingual side, enabling the application of multi-directional orthodontic forces. CAOT was performed using an Er:YAG laser (LightWalker, Fotona, Ljubljana, Slovenia) at 200 mJ, 12 Hz, 2.4 W, with a pulse duration of 100 µs, and an MSP H14 conical tip (0.6 mm spot diameter). Photobiomodulation (PBM) with a 635 nm diode laser (Lasotronix, Smart ProM, Piaseczno, Poland) was applied at 10 J per point (20 J/cm²) for 100 s per point, with a total energy of 20 J per session to reduce the risk of root resorption, manage pain, and accelerate healing as the tooth was moved into the alveolar ridge. Results: The treatment duration was two and a half years. The lingual appliance with hooks allowed precise traction of the canine, aided by exposure from the lingual side and the attachment of a hook. Gentle forces applied via orthodontic thread gradually moved the canine beneath the oral mucosa. Mid-treatment cone beam computed tomography (CBCT) scans confirmed the absence of root resorption of the lower incisors. A corticotomy, enhanced by laser therapy, was performed before moving the canine into the alveolar ridge. The canine was successfully rotated 180° and positioned without any signs of resorption in the canine or adjacent teeth. Conclusions: The use of a digitally designed and 3D-printed lingual appliance with hooks allowed the precise control of the traction of impacted teeth. When combined with corticotomy and laser therapy, it minimised root resorption risks, reduced pain, accelerated healing, and improved the overall success of the orthodontic treatment. Full article

Background/Objectives: Anterior crossbite is characterized by a reverse sagittal relationship between the maxillary and mandibular incisors. Early treatment of an anterior crossbite is advocated to avoid periodontal and traumatic consequences on lower dentition along with growth disturbances in the anterior maxilla and mandible. The present case series describes the usage of a sagittal expansion screw integrated with a removable maxillary plate or fixed appliance to correct an anterior upper single dental crossbite and outlines the clinical rationale and the protocol associated with this appliance system. Methods: A total of four children presenting anterior crossbite were treated using a sagittal expansion screw integrated into a removable plate or a fixed appliance. Results: All patients were successfully treated in less than 4 months. Overjet and overbite were normalized by the end of treatment. The orthodontic treatment received positive feedback from parents and caregivers, who seek a rapid improvement in their children’s aesthetics and function. No significant discomfort or speech difficulties were reported by the parents or patients. Conclusions: The present case series would suggest that a sagittal expansion screw, integrated into both a removable and fixed appliance, can represent a valuable and versatile treatment option for correcting an anterior crossbite. Full article

Background: One of the methods used in malocclusion treatment is the use of fixed appliances. Research conducted so far has revealed that changes in bite force occurring over the course of orthodontic treatment are directly related to the functional status of the masticatory muscles. It is therefore advisable to find out how the biomechanical parameters of the masseter muscles change after treatment with the application of fixed appliances. Methods: The study material comprised 74 individuals, divided into the study group (n = 37) treated by means of fixed orthodontic appliances over the average time of 12.27 months and the control group (n = 37) consisting of individuals did not undergo orthodontic treatment. The biomechanical properties of the masseter muscles were examined by means of myotonometry. Results: Upon completion of orthodontic treatment, the values of the parameters of tension, stiffness, and elasticity of masseter muscles located on both sides did not statistically significantly differ between patients from the study group who were treated by means of fixed orthodontic appliances and patients from control group who did not undergo orthodontic treatment. Conclusions: Treatment of malocclusions with the use of fixed appliances does not affect the biomechanical and visco-elastic properties of the masseter muscles (stiffness, tension, and elasticity) assessed by means of myotonometry and it appears safe for masticatory muscles. Full article