Search Results (809)

Objectives: The objective of this study is to evaluate the effect of 635 nm photobiomodulation on the rate and magnitude of maxillary canine distalization following extraction of the maxillary first premolars in adult patients. Materials and Methods: This randomized, controlled, split-mouth clinical trial included 18 adult patients undergoing extraction-based orthodontic treatment for Class II malocclusion. Maxillary first premolars were extracted, and canine distalization was performed using nickel–titanium closed-coil springs delivering a constant force of 150 g, supported by orthodontic mini-implants providing absolute anchorage. Photobiomodulation was applied on one randomized side using a 635 nm diode laser operating at 100 mW in continuous-wave mode, with an 8 mm handpiece diameter. Laser irradiation was delivered in contact mode to two application sites per session corresponding to the buccal and palatal aspects of the maxillary canine root, with an exposure time of 60 s per site. Irradiation was performed according to a predefined schedule over a 45-day observation period, while the contralateral side served as a sham-treated control. Tooth movement was assessed by repeated measurements of inter-bracket distance. A linear mixed-effects model was used to analyze the effects of treatment, time, and their interaction on tooth movement dynamics. Results: The linear mixed-effects model revealed a significant interaction between treatment and time (p < 0.001), indicating a greater rate of canine distalization on the photobiomodulation-treated side compared with the control side. Treatment and time also demonstrated significant main effects. After 45 days, the mean cumulative canine displacement was approximately 1.6 mm greater on the photobiomodulation side than on the control side. Age and sex did not significantly influence tooth movement. Conclusions: Photobiomodulation at a wavelength of 635 nm significantly increased the rate of maxillary canine distalization in adult extraction cases over a 45-day observation period. Full article

Background and Objectives: Dentofacial asymmetries are common in patients with malocclusions, while mild body postural asymmetries are frequently reported in otherwise healthy individuals. However, their interrelationship remains insufficiently investigated in adults without diagnosed spinal disorders. This study aimed to evaluate the association between dentofacial and body postural asymmetries in adults with malocclusions. Materials and Methods: A clinical cross-sectional observational study was conducted on 102 adults (18–45 years) with malocclusions and no spinal pathology. Standardized clinical morphometric examinations assessed dentofacial asymmetries (horizontal and vertical planes), dental parameters (dental midlines deviation and occlusal plane inclination), and body postural asymmetries (head, shoulder, trunk, pelvic, and lower limb alignment). Asymmetries were recorded using predefined clinical thresholds. Statistical analyses included the Wilcoxon signed-rank test, Pearson chi-square test, and Spearman’s rank correlation coefficient. Results: Dentofacial asymmetries were identified in both planes and occurred more frequently on the left side. Horizontal facial asymmetries were most common at the cheek (74.5%), nostril (66.7%), and mandibular angle levels (57.9%), and were influenced by sex, age, facial growth pattern, and facial profile (p ≤ 0.05). Mandibular dental midline asymmetry was present in 55.8% of patients. Body postural asymmetries were also frequent, particularly unilateral (60.8%) or anterior (55.9%) head inclination and shoulder asymmetries (54.9%), with a predominance on the left side and associations with age, body mass index, and postural attitude (p ≤ 0.05). Correlations were identified among facial asymmetries and among body postural asymmetries (p ≤ 0.01), indicating a bilateral distribution pattern. Additionally, right-sided facial asymmetries showed significant positive associations with right-sided body postural asymmetries (ρ = 0.197–0.229; p ≤ 0.05). Conclusions: Dentofacial and body postural asymmetries have been identified in adults with malocclusions and presented side-specific associations regarding the patterns of asymmetry. Full article

Background: The anatomical position of the hyoid bone and the morphological characteristics of the soft palate play a key role in upper airway patency, craniofacial balance, and the coordination of functional structures. These features may vary depending on skeletal pattern and gender. This study aimed to evaluate the relationship between hyoid bone position, soft palate morphology, skeletal classification, and gender using lateral cephalograms. Methods: A total of 120 individuals (60 females and 60 males) were classified as Skeletal Class I, II, or III based on the ANB (A Point–Nasion–B Point) angle. Measurements reflecting hyoid position and pharyngeal airway width were analyzed, including C3–H (distance from the third cervical vertebra to the hyoid bone), C3–RGn (distance from the third cervical vertebra to retrognathion), H–RGn (distance from the hyoid bone to retrognathion), PNS–UPW (distance from the posterior nasal spine to the upper pharyngeal wall), and U–MPW (distance from the uvula to the middle pharyngeal wall). Soft palate types were classified according to the You classification. Statistical analyses included ANOVA (analysis of variance), the Kruskal–Wallis test, the independent samples t-test, the Mann–Whitney U test, and the chi-square test. Results: Significant differences in C3–RGn, H–RGn, and U–MPW were observed between Skeletal Classes I–III and Classes II–III (p < 0.05). In contrast, C3–H and PNS–UPW did not differ significantly among skeletal classes. Soft palate types showed no significant association with skeletal classification or gender. Gender-based comparisons revealed significant differences in C3–H, C3–RGn, H–RGn, and PNS–UPW (p < 0.05). Conclusions: Mandibular-related hyoid measurements and the U–MPW parameter were associated with skeletal pattern, whereas C3–H and PNS–UPW remained relatively stable. Soft palate morphology was not significantly influenced by skeletal class or gender. These findings suggest that the hyoid–tongue–soft palate complex should be evaluated in conjunction with mandibular position during orthodontic diagnosis and treatment planning. Full article

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

Background/Objectives: Although the benefits of breastfeeding on the development and health of the infant are well known, the relationship between breastfeeding, oral health and attachment style or emotional bonding is not fully known. This research sought to explore, from a comprehensive perspective, the associations between breastfeeding history and children’s attachment styles, as well as the relationships between breastfeeding history and oral health indicators within conceptual psychophysiological frameworks discussed in the literature. Methods: This was a cross-sectional (descriptive and analytical) and correlational study. In this work, the associations of breastfeeding with attachment and oral health were analyzed in 100 children between 9 and 11 years old at a primary school in the municipality of José Azueta, Veracruz, Mexico, from December 2023 to September 2024 by a clinical history, dental examinations (Oral Hygiene Index-Simulated (OHI-S), Dental Caries History (DEOPT) and Detection of Malocclusions (DAI)) and the Attachment and Interaction Styles Instrument. Results: Significant differences were found in the security and closeness attachment style, the oral-hygiene index, the caries index, and occlusion by type of breastfeeding, showing better values in boys and girls who were exclusively breastfed. Likewise, both in the correlation analysis and in the multiple regression model, associations were observed between having been exclusively breastfed and the attachment style and oral indices. Conclusions: Our data show the importance of breastfeeding in pubertal children, since it was associated with better attachment and oral health; however, these findings reflect patterns of co-occurrence and should not be interpreted as causal relationships. Full article

Background/Objectives: Infraocclusion in pediatric patients may result in space loss, malocclusion and the need for complex orthodontic treatment if not detected early. Conventional diagnosis may be subject to human error and can be challenging, particularly in pediatric cases. The aim of this study is to design and evaluate a lightweight, two-stage deep learning framework with integrated explainable AI (XAI) techniques for automated infraocclusion detection in pediatric panoramic radiographs. Methods: Annotated panoramic radiographs of pediatric patients aged 7–11 years were used for training and validation. In the first stage, a MobileNet V2 Lite model was used to detect the region of interest (ROI) comprising premolars and molars. In the second stage, a custom CNN classifier was proposed to distinguish between infraocclusion and no infraocclusion. Model performance was evaluated in terms of diagnostic accuracy, computational complexity, and statistical significance. XAI techniques were also incorporated to visualize model attention and enhance interpretability. Results: The detection stage achieved high reliability with a precision, recall, F1-score, and AP50 values of 0.99, and an AP75 of 0.89, indicating accurate ROI localization. The classification stage reached an overall accuracy of 98.78%, with class-specific accuracies of 99.25% for infraocclusion and 98.31% for no infraocclusion cases. The framework also demonstrated computational efficiency, requiring only 1.88 M trainable parameters (7.19 MB), with short training times and low inference latency (0.8 ms for classification and 19 ms for detection). XAI visualizations consistently highlighted clinically relevant regions, such as occlusal margins and interproximal areas, confirming the model’s alignment with radiographic features recognized by clinicians. Conclusions: The proposed two-stage framework provides an accurate, computationally efficient, and interpretable solution for automated infraocclusion detection in pediatric patients. Its modular design and reduced complexity support practical integration into routine clinical workflows, including resource-constrained environments. These findings indicate that lightweight and XAI systems may enhance early infraocclusion detection while maintaining clinical transparency. Full article

Background: Contemporary three-dimensional morphometric analysis emphasizes quantitative modeling of anatomical interactions. However, the interplay between sagittal and vertical dimensions in determining maxillary transverse morphology remains inadequately characterized. This study introduces the Sagittal Modulation Effect (SME) framework—a model characterizing how sagittal relationships modify the association between vertical pattern and maxillary arch morphology. Methods: A retrospective cross-sectional analysis was conducted on 165 skeletally mature adults (mean age: 25.4 ± 4.8 years), stratified into skeletal Class I, II, and III groups (n = 55 each). Lateral cephalometric analysis and 3D maxillary digital models were obtained. A validated automated algorithm performed arch morphometric analyses. The primary hypothesis was tested using multiple linear regression with interaction terms, validated via bootstrap analysis and cross-validation. Results: A significant SME was identified (p < 0.001). The inverse correlation between SN-MP and maxillary width intensified progressively: minimal in Class I (r = −0.047, p_adj = 0.891), moderate in Class II (r = −0.387, p_adj_ = 0.024), and strong in Class III (r = −0.645, p_adj_ < 0.001). Regression confirmed significant interaction effects (SN-MP × Class III: β = −0.45, p < 0.001; SN-MP × Class II: β = −0.31, p = 0.003). Exploratory analysis identified cohort-specific statistical descriptors associated with narrower arches: SN-MP > 34.2° in Class III (AUC = 0.84) and SN-MP > 36.5° in Class II (AUC = 0.78). These require external validation. Conclusions: This study provides evidence that sagittal classification modulates the vertical–transverse relationship. The SME framework offers class-specific coefficients and exploratory stratification tools for future research pending multi-center validation. Full article

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

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

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

Dental conditions, including caries, periodontal disease, plaque accumulation, malocclusion, and oral mucosal abnormalities, remain highly prevalent worldwide. Early detection is crucial for preventing disease progression, simplifying treatment, and improving patient outcomes. Conventional diagnostic methods rely on subjective visual and tactile examinations, which are often inconsistent. Recent advances in deep learning (DL), particularly convolutional neural networks and vision transformers, enable automated, accurate detection of dental diseases from intraoral images captured via smartphones or dedicated imaging devices. DL-driven systems facilitate cost-effective virtual consultations, community screenings, and remote oral health monitoring. This narrative review was conducted following a structured search of PubMed, Scopus, Web of Science, Embase, and Google Scholar (October 2020–October 2025), which identified 74 eligible studies on intraoral photographic imaging-based DL systems, encompassing caries, gingival inflammation, plaque, malocclusion, and soft-tissue lesions. Most studies focused on caries, plaque, and periodontal disease using CNN and U-Net-based models, often reporting accuracies above 85% but with substantial performance drops in external validation. Despite promising results, clinical integration remains limited by challenges such as class imbalance, limited external validation, heterogeneous imaging protocols, and insufficient model interpretability. Emerging approaches, including self-supervised and federated learning, explainable artificial intelligence, multimodal data fusion, and smartphone-based diagnostics, offer potential solutions. Standardized imaging workflows, high-quality annotations, and robust clinical trials are essential to translate DL-based dental diagnostic systems into real-world practice. This narrative review aims to guide the development of reliable, equitable, and clinically deployable DL solutions for oral health assessment. Full article

Background: Intermaxillary elastics are widely used in orthodontics to deliver controlled forces for malocclusion correction, aiding in the correction of anteroposterior, vertical, or transverse problems. Despite their clinical relevance, comprehensive mechanical characterization remains limited. Objective: This study aimed to evaluate the mechanical properties of nine types of intermaxillary elastics available on the market to guide evidence-based clinical selection. Methods: Elastics were tested under uniaxial tensile loading following ISO 37:2011 and ISO 21606:2007, with six replicates per type. Load–displacement and stress–strain responses were analyzed, measuring peak force, elongation at rupture, work-to-rupture, and specific rupture work. Non-linear behavior was modeled using cubic polynomial regression, and normalized stress–strain curves enabled intrinsic material comparisons. One-way ANOVA with post-hoc tests assessed differences among elastics. Results: All elastics displayed characteristic non-linear elastomeric responses. Functional grouping distinguished short-displacement/high-stiffness, intermediate-displacement/moderate-stiffness, and long-displacement/high-capacity bands. Work-to-rupture, specific rupture work, and normalized stress–strain metrics varied significantly, reflecting differences in energy absorption and force delivery (p < 0.05). Conclusions: Mechanical characterization, including energy-based descriptors and normalized stress–strain analysis, supports informed elastic selection, enhancing orthodontic treatment predictability and patient safety. Full article

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

Background/Objectives: Pediatric sleep-disordered breathing (SDB) is influenced by craniofacial morphology and host susceptibility. Evidence integrating cephalometric airway features with targeted genetic variation in symptomatic skeletal Class II children remains limited. We explored whether children with skeletal Class II mandibular retrognathia and SDB symptoms harbor selected genetic variants and whether carriers show distinct cephalometric airway characteristics. Methods: This cross-sectional study included 48 children with skeletal Class II malocclusion, mandibular retrognathia, and snoring/mouth-breathing symptoms. Craniofacial and airway parameters were assessed on lateral cephalograms. SDB burden was evaluated by a baseline home sleep study (respiratory event index, REI). Targeted sequencing screened TNFRSF1A, PSTPIP1, SLC6A4 (5HTT), ACE, APOE, IRS1, and additionally PHOX2B and PMP22. Exploratory group comparisons used Student’s t-test. Results: Variants were identified in 13/48 participants (27%) in TNFRSF1A, PSTPIP1, SLC6A4, ACE, APOE, and IRS1; none were detected in PHOX2B or PMP22. C3–H was higher in variant carriers (39.90 ± 6.40 vs. 36.48 ± 3.95 mm; p < 0.05). HH1 (perpendicular distance from the hyoid bone to the C3–RGN line) was higher but not significant (16.99 ± 7.58 vs. 14.61 ± 5.25 mm; p > 0.05). Conclusions: In this clinically screened pediatric skeletal Class II cohort with SDB symptoms, selected genetic variants co-occurred with specific hyoid–cervical cephalometric features. Given the cross-sectional design, absence of a control group, and small number of carriers, findings are exploratory and require replication in larger, controlled cohorts with standardized phenotyping. Full article

Background/Objectives: Orthodontic mini-implants have become indispensable in modern orthodontics due to their ability to provide absolute anchorage, independent of patient compliance. Our research aims to illustrate the versatility of mini-implants in addressing diverse biomechanical challenges across different planes of tooth movement (sagittal, transverse, and vertical) based on a retrospective clinical analysis. Methods: A retrospective analysis of orthodontic treatments performed with mini-implants (Dual Top and JS systems) was conducted, focusing on predefined biomechanical objectives and outcomes. The analysis encompassed distinct biomechanical applications, including incisor retraction and space closure using sequential direct and indirect anchorage; transverse and vertical correction of adult open bite through mini-implant–assisted rapid palatal expansion (MARPE) and molar intrusion; deep bite correction via simultaneous upper and lower incisor intrusion; and unilateral molar distalization using palatal skeletal anchorage. Results: Mini-implants provided stable, reproducible anchorage in all cases, enabling complex three-dimensional tooth movements with minimal side effects. Sequential reuse of the same mini-implants for both indirect and direct anchorage reduced treatment invasiveness and enhanced anchorage efficiency. Combined skeletal expansion and posterior intrusion allowed improved transverse and vertical control in adult open-bite presentations. Pure incisor intrusion was achieved without molar extrusion or incisor proclination, while unilateral molar distalization was effectively managed using palatal skeletal anchorage. Across all cases, mini-implants enhanced treatment efficiency, reduced the need for auxiliary appliances, and ensured predictable outcomes. Conclusions: Orthodontic mini-implants represent a highly versatile and minimally invasive anchorage system adaptable to a broad range of biomechanical situations. Their ability to provide stable, reusable, and site-specific anchorage supports efficient correction of complex malocclusions and reinforces their pivotal role in contemporary orthodontic practice. Full article