Search Results (13)

Background/Objectives: This study aimed to evaluate the immediate effects of a 2-hinged expander activated with the alternate rapid maxillary expansion–constriction (Alt-RAMEC) protocol on craniofacial structures and the soft tissue periodontium in adolescents with skeletal Class III malocclusion characterized by maxillary retrusion. Methods: Lateral cephalograms obtained at baseline (T0) and immediately after treatment (T1) from 15 adolescents (6 females, 9 males; mean ages 12.6–13.1 years) treated with a 2-hinged expander using a 9-week Alt-RAMEC protocol were analyzed. A control group consisted of 27 untreated Class III individuals (7 females, 20 males; mean ages 12.5–12.6 years). Sagittal and vertical skeletal, dental, and soft tissue measurements were assessed using a Cartesian coordinate system. Periodontal parameters of supporting teeth were evaluated at T0 and T1. Statistical analysis was performed using the Mann–Whitney U and Wilcoxon tests (p < 0.05). Results: Significant anterior maxillary displacement was observed in the treatment group compared with controls (p < 0.01), accompanied by increases in overjet and Wits appraisal (p < 0.05), while mandibular position remained unchanged. The upper lip advanced in accordance with skeletal changes (p < 0.05). Gingival index, bleeding index, and probing pocket depth increased significantly in supporting teeth (p < 0.05), whereas plaque index remained stable (p > 0.05). Conclusions: The 2-hinged expander combined with a 9-week Alt-RAMEC protocol induces immediate skeletal maxillary advancement in growing Class III patients with minimal dental compensation. Short-term periodontal changes suggest a transient inflammatory response associated with appliance therapy. Full article

Background and Objectives: Tooth impaction is a common developmental dental anomaly characterized by the failure of eruption within the expected physiological timeframe. Permanent canines represent the second most frequently impacted teeth after third molars and may lead to functional, esthetic, and orthodontic complications. This systematic review aimed to synthesize current evidence regarding the incidence, anatomical distribution, etiological determinants, and diagnostic evaluation of permanent canine impaction. Materials and Methods: A systematic literature search was conducted in PubMed, PubMed Central, and ScienceDirect for studies published between December 2009 and December 2025. Studies reporting prevalence data, anatomical positioning, etiological factors, or imaging characteristics of permanent canine impaction were included. Study selection followed PRISMA 2020 guidelines, and 31 studies were included in the qualitative synthesis. Two independent reviewers screened titles, abstracts, and full texts. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Tools. Results: Thirty-one studies met the inclusion criteria and were included in the qualitative synthesis. The reported prevalence of maxillary canine impaction ranged from 0.97% to 7.10%, while mandibular impaction occurred less frequently. Palatal displacement represented the most common positional pattern. Major etiological factors included retained deciduous canines, dental arch constriction, supernumerary teeth, odontomas, and genetic anomalies such as lateral incisor agenesis. Cone-Beam Computed Tomography (CBCT) demonstrated superior diagnostic accuracy compared with panoramic radiography. Conclusions: Permanent canine impaction is a multifactorial condition predominantly influenced by local anatomical and environmental factors, with genetic predisposition acting as a secondary contributor. Early diagnosis and appropriate imaging assessment are essential to prevent complications such as root resorption and to optimize treatment outcomes. Full article

Pediatric obstructive sleep apnea (OSA) is a highly prevalent, multifactorial, and often underdiagnosed condition with significant consequences for cognitive and behavioral development. Early detection and timely multidisciplinary interventions are essential, particularly in children with craniofacial anomalies or syndromes associated with increased OSA risks, to prevent long-term complications. This narrative review explores the orthodontists’ role in the interdisciplinary management of pediatric OSA, focusing on early screening for craniofacial risk factors and implementing interceptive orthodontic interventions that support favorable airway development and growth modulation. Through early and frequent interaction with pediatric patients, orthodontists are well-positioned to identify clinical signs of airway-related abnormalities and craniofacial risk factors such as mandibular and maxillary retrognathism, maxillary constriction, and high-arched palatal vaults. Orthodontic interventions such as rapid maxillary expansion (RME), mandibular advancement, and myofunctional therapy may improve airway patency in selected cases. These approaches should be coordinated and integrated within the multidisciplinary team, including orthodontists, pediatricians, sleep specialists, ENT specialists, and speech-language pathologists. Furthermore, caregivers’ involvement and patients’ compliance are keys to success. Despite encouraging clinical observations, current evidence is limited by heterogeneity and a lack of long-term outcome data. Future research should prioritize well-designed prospective trials, explore the effectiveness of combined therapeutic strategies, and support the development of standard diagnostic protocols. Equally important is a stronger focus on early diagnosis and preventive measures to enhance patient outcomes and long-term treatment strategies. Integrating orthodontists into early OSA care is essential for optimizing outcomes and reducing long-term morbidity. Full article

Obstructive sleep apnea syndrome (OSAS) in children and adolescents is a prevalent and multifactorial disorder associated with significant short- and long-term health consequences. While adenotonsillectomy (AT) remains the first-line treatment, a substantial proportion of patients—especially those with obesity, craniofacial anomalies, or comorbid conditions—exhibit persistent or recurrent symptoms, underscoring the need for individualized and multimodal approaches. This review provides an updated and comprehensive overview of current and emerging treatments for pediatric OSAS, with a focus on both surgical and non-surgical options, including pharmacological, orthodontic, and myofunctional therapies. A narrative synthesis of recent literature was conducted, including systematic reviews, randomized controlled trials, and large cohort studies published in the last 10 years. The review emphasizes evidence-based indications, mechanisms of action, efficacy outcomes, safety profiles, and limitations of each therapeutic modality. Adjunctive and alternative treatments such as rapid maxillary expansion, mandibular advancement devices, myofunctional therapy, intranasal corticosteroids, leukotriene receptor antagonists, and hypoglossal nerve stimulation show promising results in selected patient populations. Personalized treatment plans based on anatomical, functional, and developmental characteristics are essential to optimize outcomes. Combination therapies appear particularly effective in children with residual disease after AT or with specific phenotypes such as Down syndrome or maxillary constriction. Pediatric OSAS requires a tailored, multidisciplinary approach that evolves with the child’s growth and clinical profile. Understanding the full spectrum of available therapies allows clinicians to move beyond a one-size-fits-all model, offering more precise and durable treatment pathways. Emerging strategies may further redefine the therapeutic landscape in the coming years. Full article

Class III patients have classically been managed through monomaxillary techniques, mainly involving mandibular setback movements. More recently, according to the upper incisor to soft tissue plane (UI-STP) or Barcelona Line (BL) planning protocol, bimaxillary procedures for upper maxilla advancement and reduced mandibular setback have been recommended in order to secure better aesthetic outcomes and avoid upper airway constriction. The present study describes the jaw movements in the sagittal plane performed in class III patients subjected to bimaxillary surgery following the BL protocol. A retrospective evaluation was performed on 124 class III patients subjected to bimaxillary surgery. All subjects underwent upper maxilla advancement. A total of 112 patients received mandible advancement movement (90.3%), nine received mandibular setback (7.25%), and the mandible underwent no movement along the sagittal dimension in the three remaining patients (2.4%). Mandibular advancement was significantly the most frequent treatment option. The presented results suggest that when the BL planning protocol is used as an aesthetic and functional reference, class III occlusion appears mostly related to maxillary sagittal hypoplasia instead of mandible hyperplasia, so bimaxillary advancement surgery should be considered as one of the first-choice procedures for the treatment of these patients. Full article

Background: Ankyloglossia is a congenital, abnormally short, thickened, or tight lingual frenulum that restricts tongue mobility, which may impair the development of the lower face morphology, namely the occlusion and skeleton. Objective: The aim of this study was to evaluate whether and how the lingual frenotomy benefits the occlusion and lower face skeleton development. Search methods and selection criteria: The authors, independently and in duplication, performed searches of PubMed, Cochrane Library, Medline, Web of Science, and Embase, introducing the following keywords: tongue tie, ankyloglossia, and short lingual frenum/frenulum, combined with malocclusion, lower face skeleton, and hyoid bone. Data collection and analysis: Relevant articles were assessed for quality according to the Cochrane guidelines and the data extracted for further analysis of the risk of bias and the evidence strength. Results: Seven articles including 1349 patients with ankyloglossia and 90 in the control group underwent the detailed analysis. The quality of the included studies was assessed as low. The strongest evidence of studies reporting the relationship of ankyloglossia with lower face abnormalities concerns the reduction in the intercanine and intermolar widths in either the maxilla or the mandible, as well as Class III occurrence. Limitations: The drawbacks of the analysed papers are mainly composition and number of participants. There is also a lack of good-quality prospective studies, particularly randomised clinical trials, in the literature. Conclusions: Although the lack of high-quality studies dictates that we must treat our results cautiously, the gathered evidence conditionally allow us to state the following: 1. ankyloglossia may be one of the factors contributing to maxillary constriction, Class III malocclusion, and mandibular incisor crowding; 2. the patient’s age is relevant when it comes to frenotomy timing. Possible indications for the procedure depend on the patient’s malocclusion. Full article

Class III malocclusion prevalence varies significantly among racial groups, with the highest prevalence observed in southeast Asian populations at 15.80%. These malocclusions often involve maxillary retrognathism, mandibular prognathism, or both, accompanied by maxillary constriction and crossbites. Comprehensive treatment should address anteroposterior, transverse, and vertical imbalances. Microimplant-assisted rapid palatal expansion (MARPE) has shown high success rates for transverse maxillary expansion in late adolescents and adults, presenting a viable alternative to surgically-assisted rapid palatal expansion (SARPE). This case report aims to demonstrate the successful treatment of a young adult female with borderline Class III malocclusion using MARPE and mandibular backward rotation (MBR) techniques. A 21-year-old female presented with a Class III skeletal pattern, anterior/posterior crossbites, and mild dental crowding. Despite her concerns about a concave facial profile, the patient declined orthognathic surgery due to a negative experience reported by a friend. The treatment plan included MARPE to correct maxillary transverse deficiency and MBR to alleviate Class III malocclusion severity. Lower arch distalization was performed using temporary anchorage devices (TADs) on the buccal shelves, and Class II elastics were used to maintain MBR and prevent retroclination of the lower labial segment during anterior retraction. Significant transverse correction was achieved, and the severity of Class III malocclusion was reduced. The lower dentition was effectively retracted, and the application of Class II elastics helped maintain MBR. The patient’s final facial profile was harmonious, with well-aligned dentition and a stable occlusal relationship. The treatment results were well-maintained after one year. The MARPE with MBR approach presents a promising alternative for treating borderline Class III cases, particularly for patients reluctant to undergo orthognathic surgery. This case report highlights the effectiveness of combining MARPE and MBR techniques in achieving stable and satisfactory outcomes in the treatment of Class III malocclusion. Full article

Background: Determining the correct apical limit for root canal treatment is essential for its success. This study evaluates the accuracy of three electronic apex locators (EALs) in locating the apical constriction (AC) in molar canals. Methods: Forty extracted human mandibular molars were scanned using micro-CT, and endodontic access cavities were created. Teeth were mounted in alginate, and three EALs—Root ZX-mini, Root ZX-II, and Sirona integrated apex locator—were used to measure the canal working length in dry canals and with EDTA gel. Micro-CT scans were performed with files in place, and the distance from the AC was calculated. Measurements within 0.1–0.5 mm were categorized as ‘close’. Those extending beyond towards the major foramen were categorized as ‘beyond’, otherwise they were classified as ‘far’. Data analysis was conducted with a level of significance set at 5%. Results: Most readings for all EALs were in the ‘close’ category, with significant differences between devices (p < 0.0001). Root ZX-mini and Root ZX-II had 74.4% and 72.5% ‘close’ readings, respectively, versus 51% for Sirona integrated. Accuracy did not differ significantly between dry and EDTA-treated canals (p = 0.306). All EALs demonstrated excellent operator reliability (ICC 0.996–1.00). Conclusions: All EALs accurately determined AC, unaffected by lubricants. However, Root ZX-mini and Root ZX-II outperformed Sirona integrated. All EALs showed consistent reliability. Full article

The aim of this study was to investigate buccolingual tooth movements (tipping/translation) in surgical and nonsurgical posterior crossbite correction. A total of 43 patients (f/m 19/24; mean age 27.6 ± 9.5 years) treated with surgically assisted rapid palatal expansion (SARPE) and 38 patients (f/m 25/13; mean age 30.4 ± 12.9 years) treated with dentoalveolar compensation using completely customized lingual appliances (DC-CCLA) were retrospectively included. Inclination was measured on digital models at canines (C), second premolars (P2), first molars (M1), and second molars (M2) before (T₀) and after (T₁) crossbite correction. There was no statistically significant difference (p > 0.05) in absolute buccolingual inclination change between both groups, except for the upper C (p < 0.05), which were more tipped in the surgical group. Translation, i.e., bodily tooth movements that cannot be explained by pure uncontrolled tipping, could be observed with SARPE in the maxilla and with DC-CCLA in both jaws. Dentoalveolar transversal compensation with completely customized lingual appliances does not cause greater buccolingual tipping compared to SARPE. Full article

Many species of the family Aradidae (also known as flat bugs) feed on fungal mycelia and fruiting bodies. In order to better understand the morphological adaptation to this unique feeding habit, we examined the microstructure of antennae and mouthparts of an aradid species, Mezira yunnana Hsiao, using scanning electron microscope, and documented the fungal feeding process under laboratory conditions. The antennal sensilla include three subtypes of sensilla trichodea, three subtypes of sensilla basiconica, two subtypes of sensilla chaetica, sensilla campaniformia, and sensilla styloconica. The apex of the second segment of flagellum has a large number of various sensilla forming a sensilla cluster. The labial tip is distally constricted, which is rarely observed in other Pentatomomorpha species. The labial sensilla include three subtypes of sensilla trichodea, three subtypes of sensilla basiconica, and a sensilla campaniformia. The tip of the labium has only three pairs of sensilla basiconica III and small comb-shaped cuticular processes. The external surface of the mandibular apex has 8–10 ridge-like central teeth. A series of key morphological structures associated with mycetophagous feeding habit were identified, which will facilitate future studies on adaptive evolution of species in Pentatomomorpha as well as in other heteropteran lineages. Full article

The aim of this study was to compare the crossbite correction of a group (n = 43; f/m 19/24; mean age 27.6 ± 9.5 years) with surgically assisted rapid palatal expansion (SARPE) versus a non-surgical transversal dentoalveolar compensation (DC) group (n = 38; f/m 25/13; mean age 30.4 ± 12.9 years) with completely customized lingual appliances (CCLA). Arch width was measured on digital models at the canines (C), second premolars (P2), first molars (M1) and second molars (M2). Measurements were obtained before treatment (T₀) and at the end of lingual treatment (T₁) or after orthodontic alignment prior to a second surgical intervention for three-dimensional bite correction. There was no statistically significant difference (p > 0.05) in the amount of total crossbite correction between the SARPE and DC-CCLA group at C, P2, M1 and M2. Maxillary expansion was greater in the SARPE group and mandibular compression was greater in the DC-CCLA group. Crossbite correction in the DC-CCLA group was mainly a combination of maxillary expansion and mandibular compression. Dentoalveolar compensation with CCLAs as a combination of maxillary expansion and mandibular compression seems to be a clinically effective procedure to correct a transverse maxillo-mandibular discrepancy without the need for surgical assistance. Full article

Introduction: The temporomandibular joint (TMJ) is affected in 30–45% of juvenile idiopathic arthritis (JIA) patients, with all JIA subtypes at risk for TMJ involvement. JIA patients with TMJ involvement may present with altered craniofacial morphology, including micrognathia, mandibular retrognathia, a hyperdivergent mandibular plane angle, and skeletal anterior open bite. These features are also commonly present and associated with non-JIA pediatric patients with obstructive sleep apnea (OSA). Materials and Methods: The study was comprised of a group of 32 JIA patients and a group of 32 healthy control subjects. CBCT images were taken for all patients and were imported into Dolphin Imaging software. The Dolphin Imaging was used to measure the upper airway volumes and the most constricted cross-sectional areas of each patient. Cephalometric images were rendered from the CBCT data for each patient, and the following cephalometric values were identified: SNA angle, SNB angle, ANB angle, anterior facial height (AFH), posterior facial height (PFH), mandibular plane angle (SN-MP), FMA (FH-MP), overjet (OJ), and overbite (OB). Airway volumes, the most constricted cross-sectional area values, and cephalometric values were compared between the JIA and control groups. Results: For airway values, statistically significant differences were seen in the nasopharynx airway volume (p = 0.004), total upper airway volume (p = 0.013), and the most constricted cross-sectional area (p = 0.026). The oropharynx airway volume was not statistically significant (p = 0.051). For cephalometric values, only the posterior facial height showed a statistically significant difference (p = 0.024). Conclusions: There was a significant difference in airway dimensions in the JIA patients as compared to the control patients. In addition, the posterior facial dimensions seem to be affected in JIA patients. The ODDs ratio analysis further corroborated the findings that were significant. Full article

Mandibular fractures are the second most common fractures of the face after the nasal bone. Mandibular symphyseal/parasymphyseal fracture comprises 15.6 to 29.3% of mandibular fractures. Tooth loss in the fracture line is a known phenomenon, but space loss has not been evaluated comprehensively in the literature. In a retrospective study, patients with mandibular symphyseal/parasymphyseal fractures, who had been treated from 2012 to 2013 in Mashhad University, Iran, Emdadi Hospital, were recalled. Patients with mandibular incisor tooth/teeth loss were included in the study. Space loss, the technique used to replace the lost tooth/teeth, upper and lower dental midline relationship, combination fracture or fractures in other facial skeleton, and type of treatment were evaluated. Of 98 patients with mandibular symphyseal/parasymphyseal fractures, 22.5% had incisor tooth/teeth loss. In this group, 73% had space loss. Only four patients had replaced the lost tooth/teeth. Dental midlines did not match each other in patients whose feature was evaluated. Open reduction and internal fixation with miniplates were used in symphyseal/parasymphyseal fractures except one. Space loss after mandibular symphyseal/parasymphyseal fracture with incisor tooth loss is a common error. The most important factor to prevent complications related to space loss following mandibular symphyseal/parasymphyseal fracture accompanying incisor tooth loss is space preservation. Full article