Search Results (40)

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

Background: Anterior open bite (AOB) is a complex malocclusion characterized by different vertical craniofacial growth and heterogeneous skeletal patterns, making objective diagnosis challenging using conventional cephalometric assessment alone. Recent advances in machine learning offer new opportunities to improve phenotypic characterization and diagnostic accuracy in orthodontics. Methods: This retrospective study analyzed lateral cephalometric records from 1056 orthodontic patients, comprising 621 patients with an anterior open bite and 435 healthy controls, all of whom were from the Arab population in Israel. Five clinically relevant cephalometric parameters related to vertical skeletal relationships were evaluated: the mandibular plane angle (ML-NSL), palatal plane angle (NL-NSL), posterior to anterior facial height ratio (PFH/AFH), gonial angle, and the facial axis. Statistical comparisons were made between the open bite and healthy subgroups, and these analyses were conducted in an exploratory framework to support hypothesis generation. A decision tree classifier was developed to distinguish AOB from healthy subjects using these features, and model performance was evaluated on a hold-out test set. Additionally, agglomerative hierarchical clustering was applied to explore latent craniofacial phenotypes. Results: Significant differences in vertical skeletal parameters were observed between open-bite and healthy subjects across various subgroups. The decision tree classifier achieved a test accuracy of 96.2%, with a precision, recall, and F1-score of approximately 0.97. ML-NSL emerged as the most influential feature, followed by facial axis and PFH/AFH. Unsupervised clustering identified ten distinct craniofacial clusters, including pure open bite and pure healthy phenotypes, as well as mixed clusters representing borderline or intermediate skeletal patterns. Clusters dominated by open bite cases exhibited steep mandibular planes, reduced PFH/AFH ratios, increased gonial angles, and decreased facial axis values, consistent with known vertical dysplasia patterns. Conclusions: Machine learning applied to cephalometric data enables accurate classification and meaningful phenotypic stratification of anterior open bite malocclusion. Beyond binary diagnosis, clustering analysis reveals clinically relevant subgroups that reflect varying degrees and types of vertical skeletal imbalance. These findings support the potential role of interpretable machine learning models as decision-support tools in orthodontic diagnosis and personalized treatment planning. Full article

Airway obstruction may lead to dentofacial dysmorphogenesis, with severity influenced by age, duration, and extent of obstruction. Aims: to evaluate long-term craniofacial changes in children with a history of mouth breathing, comparing outcomes between those treated with lymphoid tissue removal or with medication, and considering treatment age. Materials and Methods: Fifty-seven patients with a mean age of 19.09 years (range: 15.1–25.2 years) who had been evaluated in an earlier study (T1) were recalled at an average of 13 years follow-up (T2) and classified into a surgical group (n = 34), who had an adenoidectomy, and a non-surgical group (n = 23) treated with medication. Lateral cephalograms were obtained and compared with the original pre-treatment records. Control groups were included, matching the subjects in both groups for age and sex. Statistical analyses included group comparisons and associations among variables. Results: Significant improvement in both treatment groups were observed for the gonial angle (Ar-Go-Me), facial convexity (S-N-Me) and facial height (N-Gn), but T2-T1 changes in the surgical group were statistically significantly greater than in the medical therapy group. The palatal plane inclination to the horizontal (PP/H) and the mandibular plane inclination (MP/H) and to cranial base (MP/SN) were significantly improved in both groups (0.001 < p < 0.01). Conclusions: Both surgical and medical treatment of airway obstruction resulted in the reversal of the harmful effect of the obstruction. However, adenoidectomy was associated with greater improvements, possibly because the original obstruction was more severe and longer-standing. The results underline the importance of early recognition and management of airway obstruction to mitigate developmental orofacial dysmorphology. Full article

Background/Objectives: Precise evaluation of mandibular morphology is essential for orthodontic diagnosis, growth assessment, and treatment planning. While lateral cephalograms are traditionally used for angular measurements, orthopantomograms (OPGs) allow side-specific assessment of mandibular structures. This study aimed to analyze bilateral gonial angles, bigonial width, and ramus heights on OPGs using artificial intelligence (AI)–assisted tracing, with a focus on symmetry, sex-related differences, and clinical applicability. Methods: A cross-sectional study was conducted on 78 Romanian patients (46 females, 32 males; mean age 22.8 ± 8.7 years) seeking orthodontic treatment. Standardized OPGs were obtained and analyzed using WebCeph AI-driven software. Bilateral gonial angles, bigonial width, and ramus heights were measured. Symmetry between sides and differences between sexes were evaluated, and correlation analyses were performed. Inter-rater reliability was assessed using intraclass correlation coefficients (ICCs). Results: The mean right and left gonial angles were 126.3° and 127.1°, respectively, with no significant sex- or side-related differences (p > 0.05). Bigonial width averaged 134.9 mm, being slightly larger in males, although not statistically significant (p = 0.240). Ramus heights were comparable bilaterally (right: 48.4 mm; left: 48.3 mm), with males showing slightly greater values. Correlation analysis demonstrated strong bilateral symmetry for gonial angles (r = 0.795) and ramus heights (r = 0.895). Negative correlations were observed between gonial angles and both bigonial width and ramus height, whereas bigonial width correlated strongly with ramus height. Measurement reproducibility was high (ICC > 0.75). Conclusions: OPGs, when combined with AI-assisted analysis, provide reliable and reproducible measurements of gonial angles and ramus heights, comparable to cephalometric values. Their ability to assess right and left sides separately enhances clinical utility in detecting asymmetries and monitoring mandibular growth. However, caution is advised when interpreting transverse parameters such as bigonial width, where CBCT remains the gold standard. AI-driven OPG analysis represents a cost-effective, accessible, and low-radiation diagnostic tool with significant potential for precision orthodontics. Full article

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

Background: Sex estimation is a basic step of human identification in both legal cases and archeological contexts. The highest accuracy for sex estimation is achieved when a complete skeleton is available, though there are situations, such as cremated, dismembered, and otherwise taphonomically altered skeletal remains, where a complete skeleton is not available. The aim of the present preliminary study was to evaluate the usefulness of four non-metric skull traits that are considered taphonomically resilient for sex estimation and their potential application in forensic cases. Methods: Non-metric skull traits of 100 skulls from the Bass Donated Skeletal Collection were analyzed. These traits included foramen magnum shape, zygomatic arch extension with respect to the external auditory canal, sigmoid notch, and gonial angle muscle attachment. A discriminant function analysis model was used to develop specific formulae for sex estimation. Results: The foramen magnum and sigmoid notch showed no significant differences between males and females. The zygomatic arch extension (ZAE) and gonial angle morphology (GO) showed strong, significant differences between the sexes. However, gonial angle morphology has shown to be affected by edentulism. Based on the ZAE, the function obtained by the discriminant function analysis was sex = 2.469*ZAE − 1.247, with a result of zero pointing to males and result of one pointing to females, which correctly classified 79.8% of the original cases. Conclusions: This study highlights the value of four different skull traits and their potential use in forensic cases. Of all the evaluated traits, zygomatic arch extension was the best indicator for sex estimation. This anatomical region corresponds to a highly resistant skeletal structure. Full article

Background and Objectives: Speech sound disorders, particularly dislalia (DIS), often stem from multifactorial anatomical, functional, and emotional causes during child development. Early identification of risk factors can improve therapy outcomes and prevent long-term communicative and social impairments. This study aimed to assess the relationship between structural (orofacial anomalies, dental arch morphology, and gonial angle (GA)), emotional, and therapeutic variables as predictors of DIS and its subtypes in children aged 5–12 years. Materials and Methods: A cross-sectional observational study was conducted on 121 pediatric subjects (58 boys; 63 girls; median age 7.5 years) using clinical examination, standardized speech assessments, emotional-behavioral questionnaires, and radiological imaging(GA measurement). Associations between DIS types, TMJ function, anatomical variation, and therapy outcomes were analyzed using chi-square tests (χ²), odds ratios (ORs), and 95% confidence intervals (CIs). Results: Cleft-type (OR = 21.43; p = 0.003), asymmetrical (OR = 14.66; p = 0.004), and crossbite arches (OR = 6.43; p = 0.013) significantly predicted DIS. A GA > 130° and <120° trended toward increased speech and motor dysfunction (OR = 4.67; p = 0.086). Emotional dysregulation (ED) moderately increased the functional temporomandibular joint dysfunction (FTMJD) risk (OR = 2.26; p = 0.060). Early therapy initiation (<7 years) and FTMDJ normalization were consistently associated with superior speech improvement outcomes (OR = 3.10 and 2.40; p < 0.01). Conclusions: DIS is strongly impacted by structural craniofacial anomalies, particularly cleft-type arches and severe jaw angle deviations. Our findings provide evidence that preliminary personalized approaches and emotional regulation may be beneficial for improving treatment outcomes. These exploratory associations support the rationale for interdisciplinary screening in pediatric populations, but confirmation in multicentric and longitudinal studies is needed. Full article

Background: It has been suggested that the mandible may differ according to gender. The fact that the mandible and the anatomical structures on it show various changes with age and gender differences is important in gender and age determination. The aim of this study was to evaluate the morphometric variation in the condyle and coronoid processes and the gonial angle, which are anatomical structures forming the mandible, with gender and age. Methods: Cone beam CT images of 141 individuals (78 female, 63 male) were used in this study. The images of all patients were obtained with the same X-ray device; the images were obtained at 70 kVp, 10 mA, and a 32 s exposure time in accordance with the manufacturer’s recommendations. Images displayed with 0.3 mm voxel with the IRYS 15.0 program were examined in the axial, sagittal, and coronal planes, and measurements were taken. The gonial angle, coronoid notch, condyle height, condyle–coronoid distance, and sigmoid notch depths were evaluated. Results: The average age of 141 individuals was 43.21 ± 15.96 years, and 55.3% of them were female and 44.7% were male. The mean right gonial angle in females (128.66 ± 5.50°) was significantly higher than in males (125.68 ± 5.10°) (p < 0.005). Similarly, the mean left gonial angle in females (128.84 ± 5.97°) was significantly higher than in males (125.26 ± 4.89°) (p < 0.005). The sigmoid notch depth was found to be greater in men, with an average of 13.88 ± 2.46 mm, while in women, it had an average of 13.13 ± 1.80 mm, and this difference was statistically significant (p < 0.005). The relationship between the two sides’ coronoid notch height, sigmoid notch depth, condyle height, and condyle–coronoid distance and age groups was not statistically significant (p > 0.005). Conclusions: Overall, our findings indicate that the male mandible may have a longer condyle, a narrower gonial angle, and a wider sigmoid notch depth than that of females. It has been observed that ramus measurements such as condyle length and sigmoid notch depth may be important in gender discrimination, and the male mandible exhibits larger values in these parameters. No differences in parameters were observed between age groups. Full article

Background: In this study, we aimed to investigate the association between a patient’s selection of implant treatment for a missing mandibular second molar and the magnitude of occlusal force, masticatory ability, mandibular morphology, and age before treatment intervention. Materials and Methods: We retrospectively assessed occlusal force, masticatory performance, and mandibular morphology in female patients who either selected or declined implant treatment for a missing unilateral mandibular second molar. Results: Thirty-three women (mean age of 56.1 ± 9.7 years) were divided into an implant treatment (IT) group and a no-treatment (NT) group. The IT group showed significantly higher occlusal force (p = 0.021 < 0.05), while masticatory performance and gonial angle demonstrated no significant difference. Conclusion: The IT group had significantly higher occlusal force, and age had no significant effect on it. Notably, masticatory performance in the IT group increased significantly with age (p = 0.047 < 0.05). Full article

Background: This study aimed to compare the reproducibility and reliability of the AI-supported WebCeph and app-aided OneCeph cephalometric analysis programs with a manual analysis method and to evaluate the analysis times. Methods: The study material consisted of pretreatment lateral cephalograms from 110 cases. Cephalometric analyses were performed manually, using the WebCeph program, and using the OneCeph application. A total of 11 skeletal, 6 dental, and 3 soft tissue parameters were measured. Cephalometric analyses of 30 randomly selected cases were performed again using three methods. The analysis times were recorded. Results: The WebCeph program and OneCeph application are highly compatible with the manual analysis method in terms of all parameters, except for SN measurement. It was found that the WebCeph program and the OneCeph application demonstrated moderate agreement in U1-NA distance measurement, while statistically high agreement was observed among all three methods for other dental parameters. It was determined that there was a moderate agreement among the methods in terms of nasolabial angle, whereas a statistically high level of agreement was found for the other soft tissue parameters. The analysis time was found to be the lowest in the WebCeph program and the highest in the manual analysis method. Conclusions: The WebCeph program and OneCeph application showed a high degree of compatibility with the manual analysis method, except for SN, SNA, Gonial angle, Articular angle, U1-NA distance and nasolabial angle measurements. Due to the higher correlation between OneCeph and the manual method, it can be concluded that the OneCeph application is the best alternative to the manual method. Full article

Background/Objectives: This study aimed to compare the associations of digital measurements obtained from orthopantomographies (OPGs) or panoramic radiographs and lateral cephalograms in evaluating facial asymmetry in patients with different skeletal classes. The sample consisted of 128 Romanian patients (67 females, 61 males) who sought orthodontic treatment. These measurements are an essential diagnostic tool for evaluating facial asymmetry in order to treat them. Methods: Lateral cephalograms and OPGs were obtained for each patient, and digital tracing was performed using the WebCeph program. Angular measurements (ANB, FMA, gonial angles) and linear measurements (ramus height, mandibular body length) were assessed on both imaging modalities. Results: Strong positive correlations were found between the gonial angle and ramus height measurements obtained from lateral cephalograms and OPGs (rs range: 0.800–0.946; p < 0.001). However, the mandibular body length showed weaker correlations between the two methods. Significant sex differences were observed, with males exhibiting larger craniofacial measurements compared to females (p < 0.05). The study population was quite young, as seen by the cohort’s median age of 21 years and interquartile range (IQR) of 16 to 29 years. Lateral Ceph: the FMA angle median value of 22° (IQR: 17–25), gonial angle median of 121° (IQR: 116–127), mandibular ramus height median value of 44 mm (IQR: 41–48 mm), and mandibular body length median value of 70 mm (IQR of 65 to 76 mm). OPG: gonial angles on the right and left sides yield medians of 121° (IQR: 116–127) and 122° (IQR: 117–127); the mandibular ramus height on the right and left sides shows medians of 44.0 mm (IQR: 40.0–47.0 mm) and 43 mm (IQR: 40–48 mm); and the mandibular body on the right side presents a median of 71 mm (IQR: 67–76 mm) and the left side has a median of 71 mm (IQR: 67–75 mm). Conclusions: The findings suggest that OPGs can be reliably used to measure the gonial angle and ramus height, providing results comparable to lateral cephalograms. However, caution should be exercised when predicting horizontal measurements from OPGs. The standardization of the OPG recording process and further research with larger sample sizes are required to establish standard panoramic norms for OPG parameters in the assessment of facial asymmetry. Full article

Background: Orthodontic problems can affect vital quality of life functions, such as swallowing, speech sound production, and the aesthetic effect. Therefore, it is important to diagnose and treat these patients precisely. The main aim of this study is to introduce new classification methods for skeletal class I occlusion (SCIO) and skeletal class II malocclusion (SCIIMO) among Arab patients in Israel. We conducted hierarchical clustering to detect critical trends within malocclusion classes and applied machine learning (ML) models to predict classification outcomes. Methods: This study is based on assessing the lateral cephalometric parameters from the Center for Dentistry Research and Aesthetics based in Jatt, Israel. The study involved the encoded records of 394 Arab patients with diagnoses of SCIO/SCIIMO, according to the individualized ANB of Panagiotidis and Witt. After clustering analysis, an ML model was established by evaluating the performance of different models. Results: The clustering analysis identified three distinct clusters for each skeletal class (SCIO and SCIIMO). Among SCIO clusters, the results showed that in the second cluster, retrognathism of the mandible was less severe, as represented by a lower ANB angle. In addition, the third cluster had a lower NL-ML angle, gonial angle, SN-Ba angle, and lower ML-NSL angle compared to clusters 1 and 2. Among SCIIMO clusters, the results also showed that the second cluster has less severe retrognathism of the mandible, which is represented by a lower ANB angle and Calculated_ANB and a higher SNB angle (p < 0.05). The general ML model that included all measurements for patient classification showed a classification accuracy of 0.87 in the Random Forest and the Classification and Regression Tree models. Using ANB angle and Wits appraisal only in the ML, an accuracy of 0.78 (sensitivity = 0.80, specificity = 0.76) was achieved to classify patients as SCIO or SCIIMO. Conclusions: The clustering analysis revealed distinguished patterns that can be present within SCIO and SCIIMO patients, which can affect the diagnosis and treatment plan. In addition, the ML model can accurately diagnose SCIO/SCIIMO patients, which should improve precise diagnostics. Full article

Introduction: The fibula free flap (FFF) is regarded as the workhorse for lower jaw reconstruction in maxillofacial surgery. Imitating the preexisting shape of the mandible by an FFF while meeting various clinical and geometric aspects can be challenging, even for an experienced surgeon. To enhance the quality and reproducibility of the reconstruction process, several tools are available, mainly based on CAD/CAM techniques and the KLS L1 Mandible ReconGuide. The objective of this study was to examine the clinical use of the KLS L1^® Mandible ReconGuide compared to CAD/CAM templates. Material and Methods: In this study, we compared 25 patients who underwent mandibular reconstruction by a FFF with either the KLS L1^® Mandible ReconGuide (G1, n = 17) or personalized CAD/CAM-based cutting guides (G2, n = 8). We performed a pre- and postoperative 3D image reconstruction using standard triangle language (STL) to quantify the anatomical results in terms of volume deviations, intercondylar distance, and gonial angle, as well as clinical criteria such as surgery time, function, and postoperative complications. Results: The analysis of pre- and postoperative clinical outcomes in 25 patients revealed no statistically significant differences between the groups. However, it was observed that longer surgery time was group-independent, associated with a 5.63% increase in the length of hospital stays (p = 0.0002). In terms of geometric criteria, the only significant difference referred to the postoperative length of the symphysis, which measured 34.32 mm in G2 versus 34.78 mm in G1 (p = 0.046). Conclusions: Both the KLS L1^® Mandible ReconGuide and CAD/CAM templates seem equivalent, effective devices for standardized mandibular reconstruction, with their suitability depending on the specific indications and the segments involved. Full article

Objectives: To compare 3D cephalometric analysis performed using AI with that conducted manually by a specialist orthodontist. Methods: The CBCT scans (a field of view of 15 × 15 cm) used in the study were obtained from 30 consecutive patients, aged 18 to 50. The 3D cephalometric analysis was conducted using two methods. The first method involved manual tracing performed with the Invivo 6 software (Anatomage Inc., Santa Clara, CA, USA). The second method involved using AI for cephalometric measurements as part of an orthodontic report generated by the Diagnocat system (Diagnocat Ltd., San Francisco, CA, USA). Results: A statistically significant difference within one standard deviation of the parameter was found in the following measurements: SNA, SNB, and the left interincisal angle. Statistically significant differences within two standard deviations were noted in the following measurements: the right and left gonial angles, the left upper incisor, and the right lower incisor. No statistically significant differences were observed beyond two standard deviations. Conclusions: AI in the form of Diagnocat proved to be effective in assessing the mandibular growth direction, defining the skeletal class, and estimating the overbite, overjet, and Wits parameter. Full article

The purpose of this study was to investigate the optimization of computer-aided design/computer-aided manufacturing (CAD/CAM) patient-specific implants for mandibular facial bone defects and compare the biocompatibility and osseointegration of machined titanium (Ma), Sandblasted/Large-grit/Acid-etched (SLA) titanium, and polyetherketoneketone (PEKK) facial implants. We hypothesized that the facial implants made of SLA titanium had superior osseointegration when applied to the gonial angle defect and prevented the senile atrophy of the bone. Histologic findings of the soft-tissue reaction, hard-tissue reaction, and bone–implant contact (BIC (%) of 24 Ma, SLA, and PEKK facial implants at 8 and 12 weeks were investigated. There was no statistical difference in the soft tissue reaction. Bone was formed below the periosteum in all facial implants at 12 weeks and the BIC values were significantly different at both 8 and 12 weeks (p < 0.05). Ma, SLA, and PEKK facial implants are biocompatible with osseointegration properties. SLA can enhance osseointegration and provoke minimal soft tissue reactions, making them the most suitable choice. They provide an excellent environment for bone regeneration and, over the long term, may prevent atrophy caused by an aging mandible. The bone formation between the lateral surface of the facial implant and periosteum may assist in osseointegration and stabilization. Full article