Search Results (152)

Objectives: Oral hygiene maintenance may be influenced by both malocclusion severity and orthodontic appliance type during early orthodontic treatment. Therefore, this study aimed to evaluate the relationship between orthodontic treatment need assessed using the Index of Orthodontic Treatment Need (IOTN) and oral hygiene status measured using the Simplified Oral Hygiene Index (OHI-S) in children undergoing early orthodontic treatment and to compare short-term oral hygiene outcomes between clear aligner and removable appliance therapies. Methods: Twenty-four children aged 6–12 years with anterior dental crossbite were included in this prospective observational cohort study. Patients treated with clear aligners (n = 12) or removable appliances (n = 12) were evaluated. Orthodontic treatment need was assessed using the IOTN Dental Health Component (DHC) and Aesthetic Component (AC), and oral hygiene status was evaluated using the OHI-S at baseline and day 14. Statistical analyses were performed with p < 0.05 considered significant. Results: A statistically significant positive correlation was observed between IOTN-DHC and IOTN-AC scores (rs = 0.648; p = 0.001). Participants with higher orthodontic treatment need had poorer oral hygiene status at baseline, and this difference remained evident at day 14. Day-14 OHI-S scores were significantly higher in the removable appliance group than in the clear aligner group (p = 0.039). In addition, the reduction in OHI-S scores was significantly greater in the clear aligner group (p = 0.043). When all participants were analyzed together, oral hygiene status improved significantly from baseline to day 14 (p < 0.001). Conclusions: Higher orthodontic treatment need was associated with poorer oral hygiene status during early orthodontic treatment. Clear aligners were associated with more favorable short-term oral hygiene outcomes than removable appliances. Full article

Background and Objectives: Traumatic dentoalveolar injuries (TDI) in children often require urgent stabilization using splints. Titanium trauma splints (TTS) represent a practical option; however, pediatric evidence from hospital-based emergency settings remains limited. This study describes the clinical and contextual characteristics of children treated with TTS and explores factors associated with early complications and splint stability. Materials and Methods: A retrospective observational cohort study was conducted at a Pediatric Dentistry Service, including children with TDI managed with TTS and followed for a minimum of three months. Clinical records were reviewed to collect demographic, contextual, and clinical variables. Early complications and the need for re-splinting were recorded, and associations between selected variables and outcomes were analyzed. Results: Seventy-three patients (64.4% male; mean age 10.29 ± 2.99 years) and 127 traumatized teeth (98.4% permanent) were included. A predominance of school-based injuries was observed (52.1%). The most frequent injury types were subluxation (39.1%), avulsion (26.6%), and extrusion (16.4%). A longer interval between trauma and splint placement was associated with inflammatory root resorption (p = 0.011), although this finding should be interpreted with caution given the limited number of events. Mixed-dentition splints showed a higher likelihood of requiring re-splinting (OR = 12.23; 95% CI: 1.18–126.60); however, this estimate was imprecise and should be interpreted as an exploratory signal. Overall, 90.4% of patients completed treatment with a single splint. Conclusions: Within the limitations of this retrospective observational cohort, TTS showed satisfactory short-term clinical stability in pediatric traumatic dental injuries. Longer time between trauma and splint placement was associated with inflammatory root resorption, while mixed-dentition splints emerged as a potential signal of increased re-splinting. These findings are exploratory and hypothesis-generating and require confirmation in future studies. Full article

Orofacial clefts are among the most common congenital craniofacial anomalies in the world. Immunity factors modulate response, inflammation, and healing in clefted tissue. This study aims to evaluate the levels of the pro-inflammatory biomarkers Granulysin, Resistin, FCGR1A, NF-kßp65, and CD68 to describe and understand the morphopathological basis of inflammation. The comparison was done between patient and control samples across milk and mixed dentition age groups. In total, 14 patient samples were analyzed with a total of 10 control samples to form two distinct control groups with milk dentition age and mixed dentition age. Samples were analyzed using light microscopy, and a semi-quantitative method of evaluation and comparison was used to determine the number of immunohistochemically positive structures of patient and control samples. Statistics included Spearman’s correlation and Fisher’s exact test to compare groups and detect significant differences. NF-kßp65 in the milk dentition age group (p = 0.043 for NF-kßp65 in connective tissue, p = 0.017 for NF-kßp65 in salivary glands), and FCGR1A and CD68 in the mixed dentition age group showed statistically significant differences in the expression of palatal tissues compared to the controls (p = 0.016 for FCGR1A in connective tissue, p = 0.048 for CD68 in epithelium). Spearman’s rank correlation revealed eight very strong correlations among several factors and one strong correlation between factors. The presence of many very strong and strong Spearman’s correlations among inflammatory factors in cleft-affected individuals suggests heightened signaling in these pathways. Furthermore, the difference in the inflammatory factor expression at different dentition ages suggests variation in the inflammation character with age. Full article

Background/Objectives: Cephalometric analysis is essential in orthodontics and for studying conditions such as obstructive sleep apnea syndrome (OSAS). However, manually identifying anatomical landmarks and segmenting the pharyngeal airway on lateral cephalograms can be time-consuming and prone to errors. This study evaluates the CEPH_2D system, an AI-based tool designed to automate cephalometric landmark detection and pharyngeal airway segmentation from 2D lateral cephalometric radiographs. Methods: The system was evaluated on 35 anonymized lateral cephalograms obtained from patients aged 6–65 years, including mixed and permanent dentition cases. Two experienced clinicians generated and reviewed the ground truth annotations for cephalometric landmark localization and pharyngeal airway segmentation. System performance was assessed using mean radial error (MRE), successful detection rate (SDR), mean average precision (mAP), Dice similarity coefficient (DSC), precision, recall, and inference time. Results were compared with manual methods and existing automated tools. Results: The system reached a mean radial error (MRE) of 0.740 ± 0.793 mm for the key point detection task and a mean Dice Score (mDSC) of 0.935 ± 0.040 with an average processing time of 2.557 ± 0.504 s. Conclusions: CEPH_2D appears to be a promising adjunctive tool for automatic cephalometric landmark detection and pharyngeal airway segmentation on lateral cephalograms, although clinician verification remains advisable before clinical interpretation or treatment planning, particularly for landmarks showing higher detection errors. Full article

Background: Interceptive orthodontic treatment during mixed dentition aims to reduce malocclusion complexity and improve occlusal development. Although Invisalign^® First was introduced for Phase I therapy in growing patients, evidence regarding longitudinal occlusal outcomes and maintenance during dental development remains limited. This study described longitudinal changes in occlusal outcomes and case complexity using standardized indices in moderate-to-severe malocclusions. Methods: Records of children in early mixed dentition treated with Invisalign^® First between 2019 and 2025 were retrospectively analyzed. The full sample comprised 55 patients with complete digital occlusal records at baseline (T0), post-treatment (T1), and after a minimum 18-month follow-up period (T2), enabling longitudinal assessment using the Peer Assessment Rating (PAR) Index. All patients underwent baseline cephalometric assessment for diagnosis and treatment planning. A nested subsample of 47 patients with complete paired T0-T1 cephalometric records was additionally evaluated using a literature-based mixed dentition complexity framework adapted from Align^® clinical recommendations. Nonparametric tests (Wilcoxon and Friedman) were applied (α = 0.05). Results: Median PAR scores decreased from 22.0 (IQR 17.0–30.0) at T0 to 6.0 (IQR 1.0–8.0) at T1 and 7.0 (IQR 2.0–10.0) at T2, with no significant difference between T1 and T2 (p = 0.546). In the cephalometric subsample, global complexity decreased by 79.49 ± 22.43%, with correction rates exceeding 85% for dentoalveolar objectives and reaching 100% for posterior crossbite and open bite. Skeletal and sagittal molar components showed more limited improvement. Conclusions: Interceptive treatment with Invisalign^® First showed longitudinal reductions in occlusal complexity and high dentoalveolar correction rates, with maintenance of occlusal outcomes during follow-up as patients transitioned from mixed to permanent dentition. These findings should be interpreted as descriptive longitudinal observations within a non-controlled design. Full article

(1) Background: Posterior crossbite associated with maxillary transverse deficiency is commonly managed with maxillary expansion, yet the correspondence between laboratory activation behavior and the clinical response of nickel–titanium leaf-spring expanders remains insufficiently defined; therefore, this study aimed to compare in vitro and in vivo performance of the Leaf Expander^® and to assess their agreement. (2) Methods: A retrospective sample of 15 mixed-dentition patients (7–10 years) treated at two university centers with a Leaf Expander^® (6 mm screw; 900 g) was evaluated; interpremolar (E–E), intermolar (6–6), and intercanine (C–C) distances were recorded at baseline (T0, digital models) and at follow-up visits (T1–T5, caliper measurements), while mechanical compression testing (Instron 3365) quantified force release across the activation sequence; normality (Shapiro–Wilk), parametric analyses, and Pearson correlation were used. (3) Results Posterior crossbite correction was achieved in all completed cases, with mean total increases (T0–T5) of 5.4 mm (E–E), 4.4 mm (6–6), and 6.0 mm (C–C); early expansion (T1–T0) averaged 2.5 mm at E–E, and laboratory curves showed an activation peak followed by sustained force release (~6.5–9 N) and a residual-load phase. Agreement between declared activation and clinical response was higher for E–E and 6–6 than for C–C, which showed greater variability. (4) Conclusions: These findings support the Leaf Expander^® as an effective compliance-free slow expansion device and indicate that laboratory force behavior can help interpret the clinical expansion timeline, including delayed expression after activation. Full article

Objective: To determine the publication bias of the reported prevalence of malocclusions in Mexican children and adolescents. Background: Publication bias determination is crucial in a systematic review, helping to ensure the conclusions’ validity and reliability. Nevertheless, without accurate knowledge of disease prevalence and patterns, the health system risks inefficiency, inequity, and failure to meet the population’s needs. On the other hand, malocclusions can impair proper chewing efficiency, contributing to digestive alterations, and nutritional deficiencies among other functional, psychological, and social problems. The data of the prevalence of malocclusion is imperative to implement early interventions in health services that prevent more severe skeletal discrepancies and reduce the need for invasive treatments in adolescence or adulthood. Methods: Studies were collected from five databases, following the PRISMA and Cochrane guidelines for systematic reviews. Eligibility criteria were full-text research in which the prevalence of malocclusions was reported. The risk of bias (Hoy tool), publication bias (the Doi plot and the Luis Furuya-Kanamori (LFK) index), and quality assessments (GRADE tool) were performed. The data were combined using a random-effects meta-analysis. Results: The result of the meta-analysis suggests a high prevalence of malocclusions in mixed dentition was 50.2% (95% confidence interval [CI]: 38.9–61.5%). However, the studies showed a risk of bias and publication bias. Conclusions: In Mexico, there is a high prevalence of malocclusions among children and adolescents. However, these results are not robust enough to draw solid conclusions, due to the low certainty of the evidence. Full article

Early detection of dental caries in children is critical to prevent irreversible tooth damage and guarantee optimal oral health outcomes. However, interpreting pediatric panoramic radiographs throughout the mixed dentition stage remains a very challenging task due to overlap in anatomical structures and developmental variability. This complexity underscores the need for well curated, representative datasets that enable the development of reliable computer-aided diagnostic models. Herein, this study introduces the Mixed Dentition Orthopantomogram Dataset, a newly developed, publicly available dataset of children that was carefully labeled by dental specialists to identify proximal and occlusal caries regions in the range of 3–12 years. To evaluate the dataset’s applicability for artificial intelligence research, we benchmarked it using both classification and segmentation models. A patch-based classifier achieved an average AUC of 0.89 and Recall 0.85 in distinguishing healthy and carious regions. For segmentation, we evaluated U-Net and Attention U-Net with multiple loss functions, and the Attention U-Net trained with Focal loss achieved the best Dice score of 0.94. Collectively, these findings support the dataset’s utility for pediatric caries analysis and demonstrate the viability of deep learning approaches for mixed dentition panoramic imaging. Full article

Background. The Planas Functional Masticatory Angle [PFMA] is a functional parameter describing mandibular trajectory during mastication. Its variation across dentition stages may reflect cross-sectional physiological functional adaptation during growth. Methods. A cross-sectional pilot study recruited 30 patients [10 per group: deciduous, mixed, permanent dentition] from a university dental clinic. PFMA was measured using a standardized intraoral photographic protocol, with intra-examiner reliability assessed [ICC > 0.9]. Molar relationships were classified per Angle’s classification. PFMA differences across dentition stages were analyzed using one-way ANOVA, and molar class distributions were evaluated with chi-square tests [p < 0.05]. Results. PFMA values decreased significantly from deciduous [64.7° ± 6.9] to mixed [55.5° ± 7.8] and permanent dentition [47.2° ± 9.8] [ANOVA, p < 0.001]. Post hoc analysis revealed significant differences between deciduous and permanent stages. No significant right–left PFMA differences were observed. Class I molar relationships predominated [70%], and no significant association was found between PFMA and molar class. Conclusions. This pilot study suggests PFMA decreases with dentition progression, reflecting physiological occlusal adaptation. Class I predominance supports functional symmetry, but PFMA-molar class associations require larger samples. Longitudinal studies are needed to further explore the clinical applicability of PFMA as a functional descriptor of masticatory adaptation. Full article

Background and Clinical Significance: Vascular lesions of the face, particularly arteriovenous malformations (AVM) and mixed hemangiomas (MH), pose significant diagnostic and therapeutic challenges because of their complex anatomy, unpredictable behavior, and high risk of bleeding. Surgical planning should be individualized and often requires a staged approach with meticulous interdisciplinary coordination to ensure patient safety. The presence of a concomitant odontogenic infection further complicates management, as local inflammation may exacerbate vascular instability and increase the risk of life-threatening complications. Local inflammation and infection might cause some life-threatening conditions, especially when an abscess occurs in the area of any vascular lesion. Ensuring that the oral cavity is free from potential odontogenic infections is a particularly important issue in many complex cases, especially in patients treated for oral, head, and neck cancer or in those with other coexisting morbidities affecting the oral and facial regions. Case Presentation: A 72-year-old man was referred for management of a severe odontogenic infection associated with an extensive facial vascular lesion. The patient’s medical history was significant for arterial hypertension and chronic liver dysfunction (CLD) of unclear etiology. Complete blood testing, including coagulation assessment and liver ultrasonography, was performed, with no contraindication to surgery identified. The scope of odontogenic-related infections was scheduled for simultaneous removal during initial surgery. Preparation for surgery included the local application of sclerotherapy agents. Conclusions: Quite often, a routine panoramic radiograph can help in assessing the status of bone and dentition to undertake all necessary treatment. Severe odontogenic disease, including multiple retained roots, periapical infections, and odontogenic cystic lesions in the context of poor oral hygiene, may lead to the occurrence of possible inflammation. In case of any vascular lesion, a careful diagnostic and therapeutic strategy is needed. This case report highlights that maintaining an infection-free oral environment is a critical component of care in patients with complex facial MH and should be regarded as an essential element of overall treatment planning. Full article

Objectives: This study aimed to investigate preventive management strategies and optimal intervention timing for dental ankylosis of primary teeth complicated by suspected pre-eruptive intracoronal resorption (PEIR), providing an evidence-based framework for clinical diagnosis and management. Methods: This case retrospectively reports a 7-year-old patient with an ankylosed mandibular left second primary molar (tooth 75), exhibiting radiographic features suggestive of pre-eruptive intracoronal resorption. The patient was in the mixed dentition stage with dental crowding. Preventive and interceptive orthodontic management was implemented to address space deficiency and guide occlusal development. The timing of extraction and space maintenance of tooth 75 was guided by space regaining, PEIR lesion progression, and crown development of tooth 35. Results: The permanent successor of tooth 75 (tooth 35) erupted successfully, dental crowding was alleviated, and a favorable occlusion was established. Conclusions: Early diagnosis and timely, individualized intervention for ankylosed primary teeth play an important role in preventing malocclusion and promoting normal eruption of the permanent successor tooth. Full article

Objectives: This study evaluated the accuracy of an artificial intelligence (AI)-based cephalometric software (WebCeph version 2.0.0.) compared with manual tracing and determined whether stratifying patients by chronological age or dentition stage provides a more clinically relevant assessment of AI accuracy. Methods: Three hundred lateral cephalometric radiographs of Vietnamese patients were traced manually by an orthodontist (reference standard) and analyzed automatically by WebCeph. Intra-observer reliability was validated using ICC and Dahlberg’s error. We analyzed the data using three stratification strategies: (1) Overall; (2) Chronological age (<18, 18–25, >25 years); and (3) Dentition stage (<9 primary-early mixed, 9–12 late mixed, >12 permanent). The primary outcome was the absolute measurement difference (∣Δ∣), analyzed using the Kruskal–Wallis test and effect size (${\eta }^2$). Results: Overall, WebCeph showed high concordance with manual tracing (ICC > 0.80 for most parameters). Chronological age stratification showed weak associations with measurement error; differences between groups were largely non-significant ($p>0.05$) with a small effect size (${\eta }^2\approx 0.015$). In contrast, the dentition stage revealed significant performance disparities ($p<0.05$). Notably, accuracy for the Mandibular Arc (ICC = 0.349) and Mandibular Plane Angle ($p=0.048$) degraded significantly in the primary-early mixed group, a vulnerability obscured by chronological age-based stratification. Conclusions: Dentition stage is a more sensitive and biologically relevant predictor of AI accuracy than chronological age. While WebCeph is reliable for permanent dentition, accuracy degrades significantly in the primary-early mixed phase. Clinicians should prioritize manual verification of mandibular and incisor landmarks in mixed-dentition children. Full article

Background: This study assessed the long-term stability of dental arch changes achieved through clear aligner treatment in growing patients during the early mixed dentition stage. Methods: This retrospective study included 20 patients (mean age 8.3 ± 0.4 years) treated with clear aligners according to a standardized sequential expansion protocol. No additional auxiliaries, interproximal reductions, or retentions were used. Dental casts were collected at baseline (T0), end of treatment (T1), and two years post-treatment without retention (T2). Linear and angular measurements (arch width, molar and incisor torque, Henry’s angle, overjet, overbite, and Little’s index) were assessed on digital models. Friedman ANOVA and Wilcoxon signed-rank tests were applied (α = 0.05). Results: At T1-T0, significant transversal expansion was achieved in both arches (U6–6 mesial +2.1 mm; L6–6 mesial +2.4 mm; p < 0.05), with favorable torque changes and a reduction in overjet (−1.5 mm). From T1 to T2, only minimal, non-significant relapse was detected, except for a slight reduction in lower left molar torque (−1.1°). The T2-T0 comparison confirmed stable improvements in mesial intermolar widths (upper +2.0 mm; lower +1.6 mm), molar derotations, and overjets (−1.9 mm), with no significant loss of expansion or sagittal correction. Conclusions: Clear aligners in early mixed dentition achieved significant and stable dental arch modifications over a 2-year follow-up without the use of retention appliances. This therapeutic approach may represent a reliable interceptive option in growing patients. Full article

Eye tracking can provide quantitative indices of visual exploration and cognitive processing during radiographic image interpretation. This study examined eye-movement patterns and pupil dynamics and their associations with task performance while fifth-year dental students interpreted a single mixed-dentition panoramic radiograph under free-viewing conditions. Task performance was defined as the number of correctly identified pre-specified items (three radiographic findings plus two interpretive items: dental age estimation and the presence/absence of congenital anomalies). Eye-movement patterns were classified into four groups: clockwise (R, 29.6%), counterclockwise (L, 44.4%), saccadic (S, 16.7%), and concentrated (C, 9.3%). Clockwise scan paths were associated with higher task scores and more globally distributed fixations than other patterns (p < 0.001). Linear mixed-effects modeling suggested that task scores increased up to 120 s of viewing time, whereas longer viewing times were not associated with further improvements. Furthermore, ordinal logistic regression analysis revealed that higher task scores were significantly associated with a smaller mean pupil area across the entire viewing time, combined with a larger pupil area specifically during fixations, suggesting more selective allocation of cognitive resources. These findings indicate associations between global scan structure, time allocation, pupil dynamics, and task performance in this single-image setting. Generalization to overall diagnostic competence or other radiographs requires replication using multiple panoramic images and a broader range of verified findings. Full article

Background and Objectives: The aim of this study is to evaluate the effect of positive and negative visual aids used during verbal–active oral hygiene education on oral hygiene-related behaviors in children aged 7 to 14 years. Materials and Methods: In this single-blind design, sixty children were randomly assigned to three groups: G1:Positive visual aid, G2:Negative visual aid, and G3:Verbal–active education. Oral hygiene was evaluated using the Silness–Löe Index (plaque) and Rosenberg Organoleptic Scale (halitosis) at baseline, one week, and one month. Measurements were taken at baseline, at the end of the first week, and at the end of the first month. Data were analyzed using split-plot ANOVA. Results: The test groups did not show any statistically significant differences in terms of age (F = 0.530, p = 0.449) or gender (χ² = 1.600, p = 0.449). Additionally, the groups were similar in terms of clinical variables, including dentition stage (permanent or mixed) (χ² = 5.566, p = 0.062), presence of malocclusion (χ² = 3.801, p = 0.150), and presence of anterior dental caries (χ² = 1.250, p = 0.535). Significant reductions in both plaque and halitosis scores were observed over time in all groups (p < 0.001), and there were no statistically significant differences between the types of intervention (p > 0.05). Conclusions: This study demonstrated that both verbal education aided by positive and negative visuals and structured-only verbal education improved children’s oral hygiene and halitosis scores in the short term. Full article