Search Results (131)

Background and Clinical Significance: Juvenile ossifying fibroma (JOF) is a rare, benign, but locally aggressive fibro-osseous neoplasm that primarily affects the craniofacial skeleton of children and adolescents. Early surgical intervention is often required due to the lesion’s rapid growth and potential for significant facial deformity. Long-term functional and esthetic rehabilitation following maxillary resection in early childhood remains a clinical challenge. Case Presentation: This case reports a unique long-term follow-up of a 22-year-old female patient who underwent partial maxillary resection at the age of five due to JOF. Initial reconstructive efforts failed, necessitating a removable prosthesis to restore function and appearance. The patient experienced persistent self-consciousness and social withdrawal during adolescence, attributed to altered facial esthetics and repeated surgical disappointment. Nevertheless, prosthetic rehabilitation significantly improved mastication, phonetics, facial symmetry, and psychological well-being. Conclusions: The enduring psychosocial and functional impact of early maxillary resection for JOF and the pivotal role of prosthodontic management in long term rehabilitation are highlighted. A multidisciplinary approach that includes psychological support is suggested. This case report is among the few reports documenting long-term prosthetic outcomes for pediatric JOF patients extending into adulthood. 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

Background and Objectives: Patients with unilateral cleft lip and palate (UCLP) require a phase of infant orthopedic treatment prior to surgical cleft closure. Treatment planning in this phase necessitates a thorough understanding of maxillary growth dynamics in this period. The aim of the present study was to evaluate the quantitative and qualitative surface growth of maxillary segments in infants with UCLP. Materials and Methods: In total, 195 intraoral scans from 50 patients were obtained postnatal (T0), at monthly intervals (T1–5), and prior to surgical cleft closure at 6 months of age (T6). Surface, linear, and angle measurements of the maxillary segments were performed. Results: Significant increases in the total surface area and the surface areas of the small and large segments were observed at monthly intervals and over the overall duration. The large segment showed greater absolute growth (11.62 mm² per month, 46.57 mm² total), while the small segment had a higher percentage increase (1.49% monthly, 6.57% overall). A positive small correlation was observed between surface area growth changes in the small segment and its increase in length. Conclusions: Our results revealed distinct growth patterns of the large and small segments in amount and direction, underscoring the relevance of incorporating segment arch width in surface evaluations. Full article

Background: This study aimed to evaluate the long-term stability of maxillary molar distalization in the treatment of Class II malocclusion. Methods: This study included 40 patients (31 males and 9 females) who received fixed orthodontic treatment after maxillary molar distalization. Orthodontic models and lateral cephalograms were evaluated at three time points: pre-treatment (T1), after orthodontic treatment (T2), and long-term follow-up (T3). The mean ages of the patients’ ages at T1, T2, and T3 were 13.02, 15.97, and 22.05 years, respectively. The statistical analysis included paired t-tests and Wilcoxon signed-rank tests. The statistical significance was set at p < 0.05. Results: The statistical analysis indicated no gender-related differences. A significant distalization of maxillary first molars was observed at T2 compared to T1 (p < 0.001). Despite a minor relapse, a statistically significant distalization was observed in T3-T1 (p < 0.001). The vertical skeletal angles, which increased during the treatment period, decreased at T3-T2. The molar relationship was almost maintained after long-term follow-up (p < 0.001). Conclusions: The maxillary molar distalization achieved in the Class II treatment was maintained in the long term. The vertical skeletal measurements decreased to their initial values in the long term. The Class I molar relationship did not change during the completion of the growth. This study hypothesized that the maxillary molar distalization achieved during fixed orthodontic treatment can be maintained in the long term without significant relapse. Full article

The purpose of this systematic review is to analyze the dentoalveolar changes resulting from the use of clear aligners in the treatment of transverse maxillary deficiency among growing children in the mixed dentition stage. An electronic literature search was carried out using the following databases: PubMed, Scopus, Cochrane Library, Embase, and Web of Science. The review protocol was prospectively registered in the PROSPERO database. Eligible studies included children aged 6 to 12 years in the mixed dentition period, presenting with erupted maxillary first molars and a transverse deficiency of the maxilla, and undergoing treatment with Invisalign^® First aligners. The review encompassed various study types including retrospective and prospective designs, randomized controlled trials, preliminary studies, and case series. Two independent reviewers conducted the data extraction process. The quality of evidence was assessed using the GRADE approach. Except for studies by Bruni et al., the risk of bias in selected articles was visually summarized in a traffic light plot using the robvis tool, following the ROBINS-I methodology. For the studies by Bruni et al., a separate visual representation was created using robvis with the RoB2 evaluation framework, prepared by the authors S.E.I. and C.A. In total, 14 studies were included in the final synthesis, selected from 265 records retrieved through electronic searches and an additional 36 identified via manual screening. Several parameters were considered in order to assess dentoalveolar expansion: intercanine width, intercanine transpalatal width, intercanine dentoalveolar width, first and second interdeciduous molar width, first and second interpremolar width, first and second interdeciduous molar transpalatal width, first intermolar width, first intermolar mesial, distal, and transpalatal width, molar inclination, arch depth, and arch perimeter, and intermolar dentoalveolar width. An improvement was recorded in all parameters. The studies comparing treatment with Invisalign^® First clear aligners and rapid maxillary expander highlighted that these both determined statistically significant differences compared to the natural growth group. Treatment with Invisalign^® First in mixed dentition proved to be very effective for dentoalveolar expansion of the maxillary arch, with good control of the crown angulation of the upper first molar and an increase in the palatal area similar to RME, compared to pre-treatment or to the natural growth group. It could represent an effective and comfortable alternative to the traditional rapid maxillary expander treatment. However, further high-quality studies are required to support our current observations and verifying the stability of treatment outcomes on a long-term basis. Full article

Background/Objectives: Previous studies on clear aligner therapy (CAT) in mixed dentition primarily focused on the predictability of maxillary arch expansion. However, limited evidence is available regarding mandibular arch changes, particularly in relation to inter-arch coordination. This study aims to evaluate the effectiveness and predictability of dental expansion in both the upper and lower arches using Invisalign First^® aligners. Methods: A retrospective analysis was conducted with 15 participants. Dental expansions were assessed before and after treatment using iTero intraoral scans processed with 3D analysis software. Measurements were compared to the predicted movements planned in ClinCheck^®. Data normality was verified (Shapiro–Wilk test), descriptive statistics were calculated, and paired t-tests were performed to compare clinical and predicted expansions, with significance set at 0.05. Results: Clear aligners achieved effective dento-alveolar expansion in both arches. Predictability was higher at the cusp level than at the gingival level, indicating a tendency toward tipping movements rather than bodily expansion. The study also highlighted mandibular expansion outcomes and gingival-level discrepancies, providing new insights compared to the previous literature. Minor differences between predicted and achieved movements were observed, partly attributable to natural growth and deciduous tooth exfoliation. Conclusions: Clear aligners are effective in achieving maxillary and mandibular arch expansion in mixed dentition, with good predictability at the coronal level. Overengineering buccal root torque may help promote bodily expansion and reduce cuspal–gingival discrepancies. Further studies with larger sample sizes are needed to optimize treatment planning and predictability. Full article

Background/Objectives. With a rapid palatal expander (RPE) is reported to be effective in increasing the volume of nasal cavities, with a restoration of physiological nasal airflow. The purpose of this retrospective clinical study was to evaluate, using Cone Beam Computed Tomography (CBCT), the volumetric changes and airflow velocity changes in the nasal cavities, retro-palatal and retro-glossal airways, resulting from the use of RPE with dental anchorage (group A), also comparing these data with patients non treated with RPE (group B). Methods. Sixteen subjects (aged 9.34 years) with transverse maxillary deficiency and unilateral posterior crossbite were treated with RPE with dental anchorage. Additionally, 8 patients (aged 11.11 years) with juvenile idiopathic arthritis, who did not undergo any orthodontic treatment, were selected as a control group. Expansion was performed until overcorrection was achieved, and the device was left in place for 6 months as fixed retention, followed by another 6 months of night-time removable retention. From the retrospective evaluation, all patients presented two CBCT scans at baseline (T0) and 1-year follow-up (T1). The 3D-Slicer software was used for each CBCT to measure the nasal (VN), retropalatal (VRP), and retroglossal (VRG) volumes, while an iterative Excel spreadsheet allowed for a pilot approximated modeling and calculation of airway flow-related data. Results. Regarding mean age, a statistically significant difference (p = 0.01 *) was found between groups, suggesting that group B is closer to the pubertal growth peak. Analysis between T0 and T1 revealed: (i) a statistically significant increase for volumes VN, VRP and VRG in group A; (ii) a statistically significant increase for VN in group B; (iii) a statistically significant decrease for all variables related to airflow velocity in both groups. Furthermore, comparison between group A and B, regarding variations between T0 and T1, found a statistically significant difference only for VN. Conclusions. Within the limitations of this pilot evaluation, the treatment with RPE revealed promising outcomes for retro-palatal, retro-glossal and nasal volumes, together with clinical changes in airflow velocities. 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: Cholesteatoma, characterized by the abnormal growth of keratinizing squamous epithelium in ectopic locations, most commonly arises in the middle ear. Its occurrence in the sinonasal tract is rare and presents significant diagnostic and management challenges. These lesions can lead to severe complications like bone erosion, intracranial involvement, and orbital spread. This narrative review aims to summarize the current knowledge on cholesteatomas in these regions, focusing on epidemiology, pathophysiology, diagnosis, and treatment. Methods: A comprehensive review of the English literature was conducted, focusing on reported cases of cholesteatomas in the nasal cavity and paranasal sinuses. This review examines key aspects, including epidemiological data, imaging findings, surgical strategies, and postoperative outcomes. The role of diagnostic tools, particularly computed tomography and diffusion-weighted magnetic resonance imaging, in distinguishing cholesteatomas from other sinonasal lesions is also discussed. Results: As of March 2025, 51 cases of paranasal sinus cholesteatoma were reported. The frontal sinus is the most commonly affected site, followed by the maxillary, ethmoid, and sphenoid sinuses. Diagnosis is often delayed due to nonspecific symptoms, such as nasal congestion and recurrent infections. Surgical excision is the primary treatment, with endoscopic techniques being favored for their minimally invasive nature. Recurrence remains a major concern, and although very rare, cases of squamous cell carcinoma have also been observed in association with cholesteatoma. Conclusions: Nasal and paranasal sinus cholesteatomas require early recognition and intervention to prevent complications. Advances in imaging and surgery have improved outcomes; however, further research is needed to refine therapies and understand disease mechanisms. Full article

Background: This study investigated the effects of preoperative maxillary plates on cleft width reduction in infants with unilateral cleft lip and palate and their control group. The study also aimed to compare the digital and manual methods in measurement of changes in maxillary segment positioning in sagittal and transverse dimensions using digital 3D models and conventional plaster casts. Methods: Twenty infants with unilateral cleft lip and palate and their control group of eleven infants with isolated cleft palate were enrolled in a prospective interventional study (2020 to 2024). Participants were treated with either active or passive maxillary plates. Sagittal, transversal and angular measurements were taken both manually as well as digitally at three time points: 24–48 h postnatal (T0), approximately at six months old (T1, immediately before surgery), and one year postoperatively (T2). Results: Significant reductions in cleft width were observed across all patients over the treatment period, regardless of the type of plate used (p < 0.001). The mean cleft width reduction was 5.050 mm. Infants treated with active plates had a larger reduction in cleft width than those with passive plates (p = 0.024), averaging 5.846 mm compared to 3.571 mm. Neither the side of the cleft nor the patient’s gender influenced the degree of cleft reduction (p = 0.884 and p = 0.245, respectively). The study found significant modifications in the maxilla’s transverse, sagittal, and angular dimensions (p < 0.001). When comparing sagittal growth, the study group differed from the control group (p = 0.004), with isolated cleft palate patients showing more substantial sagittal expansion. Additionally, the overall change in the ITT’ distance differed significantly between the study and control groups over time (p < 0.001). Cleft size at baseline did not affect the extent of changes within the cleft area. No significant discrepancies were found between digital and manual measurement methods, confirming the reliability of both. Conclusions: Active plates demonstrated greater efficacy in cleft reduction for wider and more divergent clefts, while passive plates were suitable for smaller clefts. Full article

Maxillary canines have a vital importance in the dental arches, both esthetically and functionally. They are the second most frequently impacted teeth, with palatal impaction being the most common. The purpose of the study was to evaluate the prevalence of palatally displaced canines (PDC) and their association with dental and skeletal anomalies. A retrospective analysis was conducted on 68 patients. A panoramic and a lateral cephalometric radiograph were performed to determine impaction type and patients’ dental and skeletal characteristics. The analysis grouped all PDC cases together and then subdivided them by location (right, left, or bilateral impaction). The most frequent PDC was right-side impaction. When all cases were grouped together, patients showed no family history of PDC (p < 0.05) or presence of dental anomalies (p < 0.05). No relation to skeletal class was observed, but a normodivergent growth pattern did show an association (p < 0.05). When different PDC types were analyzed separately, we observed a relationship with dental midline deviation (F = 17.04, p < 0.05), family history of PDC (F = 12.56, p < 0.05), and lateral incisors anomalies (F = 9.58, p < 0.05). Therefore, an association was found between PDC and dental anomalies when the types of impaction were analyzed separately and with the growth pattern when PDC cases were grouped together. Full article

Background/Objectives: This retrospective study used computer fluid dynamics (CFD) to evaluate the medium-term changes in the upper airways (UA) airflow after rapid maxillary expansion (RME) in three age-matched groups with different degrees of adenoidal obstruction. Methods: The sample included Cone-Beam Computed Tomography (CBCT) of 67 adolescents taken before (T0) and 12 months after RME (T1) and divided into three cohorts: Control Group (CG, <25% obstruction: 24 subjects, mean age = 11.8 ± 1.3), Adenoids Group 1 (AG1, >25% <75% obstruction: = 22 subjects, mean age = 10.9 ± 1.5), Adenoids Group 2 (AG2, >75% obstruction: = 21 subjects, mean age = 11.2 ± 1.6). The airflow pressure, velocity and obstruction were simulated using computer fluid dynamics (CFD). Results: The pressure significantly improved in CG and AG1 groups while the velocity improved in AG1 as well as the prevalence of obstruction improvement. The airflow pressure and velocity changes could be attributed to the reduction of the resistances in the adenotonsillar region, which was remarkably more marked in the AG1. Conclusions: Alterations in the adenotonsillar region likely represent the most substantial factors influencing airflow changes after RME. The integration of anatomical and functional data, along with the identification of baseline patient characteristics, may facilitate the characterization of phenotypes most appropriate for initial management through either Rapid Maxillary Expansion (RME) or otolaryngologic (ENT) interventions. Full article

Background: Childhood obesity and overweight conditions impact systemic health and craniofacial development. Objectives: This review assessed the influence of elevated body mass index (BMI) on craniofacial morphology, considering age, sex, and ethnicity. Methods: A comprehensive search of Scopus, Web of Science, Embase, Cochrane, PubMed, and OpenGrey was conducted following PRISMA guidelines. Ten cross-sectional studies involving 1383 individuals aged 6 to 18 years were included. The sample comprised 812 females and 571 males, with most studies focusing on adolescents aged 12–18 years of different ethnicities depending on the study. Craniofacial structures were compared between overweight/obese and normal weight groups through cephalometric analysis. Study quality was assessed using the Newcastle–Ottawa Scale (NOS). Results: Overweight and obese individuals showed significant craniofacial changes, including increased anterior cranial base length, maxillary and mandibular dimensions, bimaxillary prognathism, and greater soft tissue thickness. These alterations may be influenced by differences in tissue composition, hormonal fluctuations, fat-to-bone ratio, and metabolic disorders. Variations in skeletal divergence, dental alignment, and airway space were also observed. The methodological quality ranged from moderate to high. Conclusions: Excess weight during growth is linked to distinct craniofacial alterations. Orthodontic diagnostics should integrate metabolic and hormonal considerations to optimize treatment outcomes. These changes should be carefully considered by orthodontists and pediatric dentists. Longitudinal studies are needed to understand the long-term effects of obesity on craniofacial development. Full article

As advancements in digital technologies reshape the modern healthcare, integrating digital impression techniques, such as intraoral 3D scanning and 3D analysis and treatment planning, is becoming increasingly essential in the standard care of infants with cleft lip and palate. This study introduces a novel digital measurement method designed specifically for analyzing digital models of infants with unilateral cleft lip and palate, utilizing OnyxCeph³™ software within the interdisciplinary framework of the Frankfurt approach. To support its integration into routine clinical practice, we outlined the complete digital workflow—from data acquisition through intraoral 3D scanning to model preparation and processing. Our method involves precise anatomical and constructed measurement points and diverse distances and angles to evaluate sagittal, transverse, and vertical parameters comprehensively. By leveraging OnyxCeph³™ software for computer-aided measurements of digital 3D models, this approach aims to enhance the accuracy and efficiency of cleft treatment planning, facilitating more informed, personalized care decisions and ultimately improving patient outcomes. Full article

Maxillary deficiency, a common transversal dentofacial deformity, affects aesthetics and function. Timely intervention during adolescence is crucial, as the growth potential of the maxilla provides an opportunity to optimize treatment outcomes. This review explores various approaches for adolescent maxillary expansion, including orthopedic and surgical methods. Orthopedic appliances effectively address transverse deficiencies without surgery and are particularly beneficial in managing conditions in children and early adolescents. In mid- to late-stage adolescents, bone-borne devices with mini-surgery offer better skeletal expansion outcomes. However, in cases of severe deficiencies, or where skeletal resistance limits non-surgical methods, surgical interventions become essential. Procedures like surgically assisted maxillary expansion and orthognathic surgery offer superior skeletal corrections. These techniques are particularly valuable for late adolescents with complex conditions. This review comprehensively summarizes the applications, outcomes, and limitations of these treatment options, highlighting the importance of selecting individualized, growth stage-appropriate interventions. Full article