Search Results (548)

Akkermansia muciniphila (AM) is a Gram-negative commensal bacteria that has been found in both the oral cavity and gastrointestinal tract and has the ability to maintain homeostasis in the intestinal tract by inducing anti-inflammatory responses. The purpose of this study was to evaluate the presence of AM in the oral microbiome of patients with and without orthodontic appliances to determine any associations with other oral bacteria. This retrospective study of orthodontic and non-orthodontic saliva samples (n = 209) was screened by qPCR analysis for AM, Scardovia wiggsiae (SW), Selenomonas noxia (SN), Streptococcus mutans (SM), Porphyromonas gingivalis (PG), Treponema denticola (TD), and Fusobacterium nucleatum (FN). These data revealed oral microbial prevalence between 29.8% (AM) and 54.3% (SM)—with orthodontic samples revealing decreased AM prevalence (−29.5%), compared with non-orthodontic samples and corresponding increased prevalence of PG (+2.7%), TD (+13.7%), SM (+22.2%) and SN (+26.0%). AM-positive samples exhibited decreased prevalence of SN (−16.0%), SM (−1.6%), PG (−10.2%), TD (−4.2%), and FN (−14.3%). These findings may suggest that orthodontic appliances may be associated with decreased AM prevalence, which may be associated with increased prevalence of other oral pathogens. Full article

Background/Objectives: Patient-facing artificial intelligence chatbots are increasingly used as informal digital health education tools. In orthodontics, eating and drinking advice may directly affect appliance integrity, oral hygiene, enamel demineralization, caries risk, and clear aligner use. This study compared the understandability, actionability, overall quality, and potential harmfulness of responses generated by free and paid versions of ChatGPT and Gemini to patient-oriented orthodontic dietary questions. Methods: This cross-sectional comparative observational study evaluated 160 responses generated from 40 Turkish patient-oriented orthodontic eating and drinking questions across five clinically relevant categories. Each question was submitted separately to ChatGPT free version, ChatGPT Plus, Gemini free version, and Gemini Pro on 1 May 2026, using newly opened independent chat sessions without prompt engineering, follow-up prompts, response regeneration, or manual editing. Responses were anonymized, randomly coded, and independently evaluated by two specialist dentists. PEMAT-P actionability was defined as the primary outcome. PEMAT-P understandability, Global Quality Score, and potentially harmful advice classification were secondary outcomes. Repeated-measures comparisons were performed using Friedman tests and Bonferroni-adjusted Wilcoxon signed-rank tests. Results: PEMAT-P understandability was high across all groups, with median scores of 100.0 in every group. Significant group differences were found for understandability, actionability, and Global Quality Score. ChatGPT Plus achieved the highest actionability score and Global Quality Score and produced no responses classified as potentially harmful. Potentially harmful responses were identified in ChatGPT free version, Gemini free version, and Gemini Pro. For the primary outcome, PEMAT-P actionability, the overall group difference was statistically significant with a small effect size (χ² = 20.527, p < 0.001, Kendall’s W = 0.171), while the largest effect was observed for GQS with a moderate effect size (χ² = 46.520, p < 0.001, Kendall’s W = 0.388). Conclusions: All chatbot groups generated highly understandable responses; however, actionability, overall quality, and safety varied across systems. ChatGPT Plus showed the strongest overall performance under the specific interface, subscription, language, and date conditions tested; however, this finding should be interpreted as a time-specific benchmark rather than evidence that paid chatbot systems are intrinsically safer or more clinically reliable. Structured evaluation, transparent reporting, digital health equity considerations, and professional oversight remain necessary before AI-generated orthodontic dietary advice can be integrated into routine patient education. Full article

Directly 3D-printed clear aligners are increasingly adopted for orthodontic treatment, but lack intrinsic antibacterial properties. This study investigates the integration of silanized chitosan nanoparticles (CSNPs) into 3D-printed clear aligner resin to improve antibacterial activity while preserving optical, polymerization, and mechanical performance. Commercial CSNPs were surface modified with 3-(trimethoxysilyl)propyl methacrylate and characterized using FTIR, UV-Vis, TEM, EDS, XRD, DLS and zeta-potential analysis. The silanized CSNPs were incorporated into TA-28 clear aligner resin at 0.01, 0.05, and 0.1 wt%. Antibacterial activity against Streptococcus mutans (S. mutans) and Porphyromonas gingivalis (P. gingivalis) was assessed using bacterial adherence and biofilm assay. Transparency, degree of conversion, tensile and flexural properties were evaluated. Successful silanization was confirmed by characterization analyses. The incorporation of silanized CSNPs reduced bacterial adherence and biofilm formation significantly in comparison with the control group (p < 0.001). The transparency was maintained at 0.01 and 0.05 wt% but reduced significantly at 0.1 wt% (p < 0.001). While all nano-modified groups had a lower DC% than the control group, values remained above 75%. Mechanical performance showed improvements, particularly in stiffness and flexural properties, following nanoparticle incorporation. Among the tested concentrations, the 0.05 wt% CSNPs provided the most favorable overall performance, highlighting their potential for the development of next-generation bioactive clear aligners. Full article

Background/Objectives: Single-retainer Maryland adhesive restorations provide a minimally invasive fixed option for replacing missing anterior teeth in young patients. When congenital absence of a maxillary lateral incisor is associated with a contralateral conoid lateral incisor, the clinical problem extends beyond tooth replacement to bilateral symmetry management. This case report describes a digital-restorative workflow combining a single-retainer lithium disilicate Maryland adhesive restoration with a pontic-derived stamp technique for contralateral symmetry correction. Methods: A medically healthy 13-year-old patient presented with congenital absence of the maxillary left lateral incisor (FDI 22; Universal 10) after orthodontic treatment and had been wearing a removable appliance to replace the single missing tooth. The contralateral maxillary right lateral incisor (FDI 12; Universal 7) presented with conoid morphology, further compromising anterior symmetry. Clinical assessment confirmed ideal mesiodistal space at FDI 22, a vital and unrestored FDI 21 with intact enamel and healthy periodontal support, and the absence of abnormal overjet, overbite, or excursive contact pattern. Based on the findings, a single-retainer Maryland adhesive restoration was fabricated from lithium disilicate (IPS e.max CAD) and bonded to the maxillary left central incisor (FDI 21; Universal 9) using an enamel-only preparation and adhesive cementation protocol. The fixed restoration was combined with a pontic-derived stamp workflow to guide direct composite reshaping of the contralateral conoid lateral incisor. Results: At 1-year follow-up, no debonding, sensitivity, marginal discoloration, or soft-tissue inflammation was observed. The contralateral composite reshaping remained clinically stable, and the patient and guardian reported improved comfort and esthetic satisfaction compared with the previous removable appliance. Conclusions: This case suggests the short-term clinical feasibility of combining a single-retainer lithium disilicate Maryland adhesive restoration with a pontic-derived stamp workflow to achieve minimally invasive tooth replacement and contralateral symmetry correction. Longer follow-up and broader case series are required to confirm the long-term predictability and reproducibility of this approach. Full article

Background: Temporary anchorage devices (TADs) are considered an essential and reliable component of orthodontic fixed appliance therapy, providing stable skeletal anchorage with minimal dependence on patient compliance. Objective: This study aimed to evaluate the success rate of orthodontic mini-implants and to assess the influence of patient- and treatment-related factors on their stability and success rate. Materials and Methods: A retrospective analysis of 60 patients was conducted with a total of 121 inserted TADs. Patient sex, age, orthodontic diagnosis, insertion site, and bone quality were analyzed, and descriptive statistics were calculated for all variables. Associations between categorical variables were evaluated using Pearson’s chi-square test. Variables showing potential association were further analyzed using multivariate binary logistic regression to identify independent predictors of mini-implant success. Results: No statistically significant associations were found between implant success and patient sex (p = 0.240), age (p = 0.819), or insertion site (p = 0.069); however, a trend toward higher failure rates in palatal-placed implants was noted. Logistic regression analysis did not identify any independent predictors of success (p = 0.284), and the model explained only a small proportion of outcome variability (5.9–12.0%). Conclusions: The high success rate of the TADs demonstrated high clinical reliability in this study, although patient-related factors such as age and sex did not significantly influence the success rate. Bone quality and soft tissue characteristics may contribute to TAD stability; however, these factors were not directly quantified in the present analysis. Full article

Background/Objectives: Traumatic dental injuries involving the maxillary anterior teeth are common; however, combined extrusive and lateral dislocation during active orthodontic treatment is uncommon and presents unique management challenges. This case report describes the multidisciplinary management of traumatic extrusive and lateral dislocation of the maxillary right lateral incisor (#7) and maxillary right central incisor (#8) in a 27-year-old patient undergoing fixed orthodontic treatment following sports-related trauma. Methods: Clinical examination revealed marked coronal and lateral displacement, pathologic mobility, gingival laceration, active bleeding, and deformation of the orthodontic archwire. Both affected teeth had complete root formation. Emergency management included immediate repositioning of the displaced teeth and urgent endodontic treatment. Semi-rigid stabilization was achieved using metallic ligatures and a rectangular stainless-steel orthodontic archwire, supplemented by temporary skeletal anchorage with a mini-screw and posterior bite turbos to reduce occlusal loading. The patient was monitored clinically and radiographically throughout healing and subsequent orthodontic treatment. Results: Follow-up examinations demonstrated favorable periodontal healing, stable retention of the traumatized teeth, absence of pathologic mobility, and successful continuation of orthodontic treatment. Radiographic evaluation showed no evidence of inflammatory root resorption or other significant complications. At the 16-month follow-up, the affected teeth remained functional and stable, and implant placement was successfully completed at the congenitally missing maxillary canine site. Conclusions: This case highlights the importance of immediate interdisciplinary management of traumatic dental dislocation during orthodontic treatment. Fixed orthodontic appliances, when appropriately incorporated into emergency stabilization protocols, may contribute to successful tooth retention and favorable long-term outcomes. Full article

Background/Objectives: The critical role of oral hygiene in overall health has driven efforts to improve oral hygiene practices. Novel devices employing electric-based technologies have emerged as powerful allies to conventional mechanical approaches for plaque control. NeoPill is a novel electric oral hygiene device designed to assist individuals with fixed orthodontic appliances in maintaining oral hygiene efficiently. The device utilizes direct current (DC) to facilitate bacterial removal from tooth surfaces and gingival tissues. Although the antimicrobial effects of electric-based devices, including NeoPill, are recognized, evidence concerning their impact on salivary biochemical parameters is scarce, especially in relation to oxidative stress. This pilot study aimed to evaluate the effects of NeoPill-derived DC on the redox status of saliva samples obtained from smokers. Methods: Saliva samples were analyzed after a 30-s exposure to NeoPill-derived DC and compared with untreated samples. Salivary pH, buffering capacity, and total protein concentration were measured, along with key salivary biomarkers of oxidative stress and antioxidant capacity. Results: The applied treatment did not significantly affect salivary pH, buffering capacity, or total protein content. Furthermore, NeoPill-derived DC treatment did not induce reactive oxygen species production or lipid peroxidation. No changes were observed in reducing power, glutathione-dependent defense, or the activities of antioxidant enzymes, including catalase and superoxide dismutase. Conclusions: These findings suggest that NeoPill-derived DC does not alter the redox status of smokers’ saliva under the applied conditions. However, it should be noted that this is a preliminary study with a small sample size, which represents a key limitation. Full article

Background/Objectives: Tooth impaction and transposition are developmental dental anomalies that pose significant challenges in orthodontics, oral surgery, and restorative dentistry. These anomalies disrupt normal occlusal development and complicate diagnosis and treatment planning because of altered anatomy, a higher risk of adjacent tooth resorption, associated pathology such as cyst formation, and biomechanical challenges during orthodontic intervention. Methods: Three paediatric patients with complex eruption disturbances, including impacted incisors, impacted primary molars, and transposed maxillary canines, were managed using individualised conservative orthodontic approaches. The cases involved obstruction by supernumerary teeth, ectopic eruption with space loss, and tooth transposition complicated by root dilaceration and malocclusion. Comprehensive clinical and radiographic assessment, including CBCT when indicated, guided treatment planning. Management strategies included staged surgical interventions, space maintenance using 2 × 4 appliances, bite opening, and controlled orthodontic traction with modified biomechanics to minimise the risk of root resorption and interference with adjacent teeth. Results: Favourable functional and aaesthetic outcomes were achieved in all cases, although certain limitations such as incomplete root development, residual spacing, localised restorative complications, and difficulty in correcting root angulation of dilacerated adjacent teeth were observed. Conclusions: Careful diagnosis using advanced imaging, combined with conservative orthodontic and surgical approaches, can achieve satisfactory functional and esthetic outcomes while minimising complications. Further longitudinal studies are recommended to evaluate long-term stability and optimise treatment protocols. Full article

Objectives: To explore volumetric changes in the nasopharynx, oropharynx, hypopharynx, and total pharyngeal airway after Class II functional orthodontic treatment and to relate these anatomical changes to patient-reported breathing and sleep comfort. Methods: A retrospective observational study of 63 growing patients (11–14 years) with Class II mandibular retrusion was conducted. Pre- and post-treatment cone beam computed tomography (CBCT) scans (NewTom 5G) were exported as uncompressed digital imaging and communications in medicine (DICOM) files and analyzed with Dolphin Imaging v11.9. The pharyngeal airway was manually segmented into naso-, oro-, and hypopharyngeal regions; volumes were measured twice by a single examiner to assess reliability. Inter-examiner reliability was assessed in a 15-patient subgroup. Patients completed a 5-point Likert rating of perceived breathing and sleep changes. Statistical tests included Wilcoxon signed-rank, Friedman with Holm post hoc, Mann–Whitney U, and Spearman correlation; p < 0.05 was considered significant. Results: Intra-examiner reliability was excellent (ICC1 mean 0.988), and inter-examiner reliability was good to excellent (ICC2 0.87–0.95). Mean total pharyngeal airway volume during the treatment interval in growing Class II patients treated with functional appliances increased from 18,183.62 mm³ at T0 to 23,524.42 mm³ at T1—an average augmentation of approximately 5340.80 mm³ (~29.4%). Regional gains followed the following pattern: Oropharynx > Nasopharynx > Hypopharynx. Nasopharyngeal and total airway changes were found to be associated with improvements in reported breathing (ρ = 0.79 and 0.69) and sleep comfort (total airway ρ = 0.74). Conclusions: Functional mandibular advancement in growing Class II patients was associated with enlargement of the pharyngeal airway—most notably in the oropharynx—and these volumetric gains were followed by improved patient-reported breathing and sleep comfort within the limitations of retrospective study design. Full article

Background: Orthodontically induced external root resorption (ERR) may affect long-term tooth stability, requiring a reliable assessment of root length changes. This study developed an artificial intelligence (AI)-based framework for automatic segmentation and quantitative evaluation of root resorption, comparing fixed appliances and clear aligner therapy. Methods: A dataset of 100 anonymised orthopantomographic (OPG) radiographs (50 fixed appliance, 50 clear aligner) obtained before and after orthodontic treatment was analysed. A U-Net model was trained for automatic tooth segmentation and quantitative assessment of tooth length changes. Measurements were computed from both AI-predicted and Dentist-annotated masks using pixel-based Python analysis (Python version 3.6), and pre-post differences were compared between methods. Results: The segmentation model achieved high performance with Intersection over Union values up to 89% and Dice Similarity Coefficients up to 95%. Quantitative analysis demonstrated significant reductions in root length following orthodontic treatment in both modalities (p < 0.0001). In the fixed appliance group, AI-based measurements showed an average root length reduction of 8.95%, while human measurements indicated a reduction of 10.16%. In the clear aligner group, AI measurements demonstrated a reduction of 2.81%, compared with 4.98% in human measurements. Root resorption was significantly greater in the fixed appliance group than in the clear aligner group (p < 0.0001). AI-derived measurements showed strong agreement with expert evaluations. Conclusions: AI-based analysis of panoramic radiographs may provide a reliable and reproducible approach for quantifying orthodontically induced root resorption. The findings suggest that clear aligner therapy was associated with lower root length reduction; however, larger multi-centre studies and external validation are required before clinical implementation. Full article

Background: Rapid palatal expansion (RPE) is the gold standard for maxillary deficiency in growing patients. Conventional soldered expanders often present challenges in adaptation, chairside procedures and bond stability. This study compares traditional RPEs with customized CAD (Computer Aided Design)/CAM (Computer Aided Manufacturing) expanders regarding clinical efficiency and patient experience. Methods: Thirty growing patients (mean age: 9.2 ± 1.1 years) were allocated to two groups: traditional RPEs (n = 15) and customized CAD/CAM RPEs (n = 15). Outcomes included bond failures, chairside time (from initial try into cementation) and short-term patient-reported discomfort via a 10-point Visual Analogue Scale (VAS) 24 h after appliance placement. Significance was set at p < 0.05. Results: The CAD/CAM group showed significantly fewer bond failures (0.2 ± 0.4 vs. 1.1 ± 0.8; p < 0.05) and shorter chairside time (12.4 ± 2.1 min vs. 24.6 ± 3.8 min; p < 0.001). Patient discomfort was also significantly lower in the CAD/CAM group (VAS: 4.1 ± 1.0 vs. 6.3 ± 1.2; p < 0.05). Conclusions: Within the limitations of this pilot exploratory non-randomized study, customized CAD/CAM RPEs were associated with fewer bond failures, shorter chairside application time, and lower short-term discomfort at 24 h compared with traditional appliances. These preliminary findings should be interpreted with caution and confirmed by larger randomized controlled studies. Full article

Background: Pain during orthodontic debonding is a common clinical concern. Although previous studies have mainly focused on mechanical approaches to reduce discomfort, the influence of emotional characteristics of patients on pain perception remains insufficiently explored. In this study, we aimed to evaluate the association between pain perception, emotional affect, and anxiety during orthodontic bracket removal using different clinical protocols. Methods: A prospective observational comparative study was conducted at Rey Juan Carlos University (Madrid, Spain). A total of 140 orthodontic patients underwent bracket removal according to four routine clinical protocols determined by clinical scheduling: ligated with interocclusal cotton rolls (used for tooth stabilization), non-ligated with cotton rolls, ligated without cotton rolls, and non-ligated without cotton rolls. Pain intensity was assessed using a Visual Analog Scale (VAS) immediately before (T0) and after (T1) bracket removal. Baseline pain (T0) was recorded to control for pre-existing discomfort. Anxiety and emotional affect were measured using the State–Trait Anxiety Inventory (STAI) and the Positive and Negative Affect Schedule (PANAS), respectively. Statistical analyses included ANOVA, factorial ANCOVA adjusted for baseline pain, and multivariable regression models. Results: No significant baseline differences were observed among groups. The highest post-debonding pain scores were found in the group without cotton rolls and without ligatures. ANCOVA revealed a significant main effect of cotton roll use, with lower adjusted pain scores in patients treated with cotton rolls, whereas ligation showed no statistically significant independent effect. In multivariable regression analyses, baseline pain, age, and negative affect were independently associated with higher post-debonding pain. Conclusions: Within the limitations of a non-randomized design, cotton roll use was associated with lower post-debonding pain, whereas ligation appeared to have a limited influence. Patient-related factors—particularly negative affect, age, and baseline pain—were also associated with pain perception, supporting a biopsychosocial perspective. These findings should be interpreted as exploratory evidence rather than causal effects. Full article

Objectives: This study aimed to evaluate and compare the cost-effectiveness of the surgery-first and orthodontic-first approaches in Thai patients with dentofacial deformities undergoing orthognathic surgery. Methods: This retrospective cohort study included 30 patients with dentofacial deformities, divided into the surgery-first approach (SFA, n = 15) and orthodontic-first approach (OFA, n = 15). All underwent double-jaw surgery without genioplasty performed by a single surgeon and orthodontist. Data collected included operative and orthodontic costs, operative time, total treatment and hospital costs, treatment duration, and length of hospital stay. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER) and incremental time-effectiveness ratio (ITER), with effectiveness measured by quality of life via the Thai Orthognathic Quality of Life Questionnaire (OQLQ) before and at the time of debonding the orthodontic appliance. Results: Overall, the SFA demonstrated greater cost-effectiveness than the OFA. However, the SFA group incurred slightly higher hospital costs. There were no statistically significant differences between the two groups in operative cost, hospital cost, total cost, operative time, or length of hospital stay (p > 0.05). By contrast, orthodontic cost, orthodontic treatment duration, and total treatment duration were significantly lower in the SFA group compared with the OFA group (p < 0.05). Conclusions: Within limits, the SFA is a potentially beneficial alternative to OFA. Patients and clinicians may benefit from using SFA by experiencing shorter treatment duration, lower orthodontic treatment costs, and improvements in certain aspects of quality of life. Further studies with larger sample sizes and longitudinal data are necessary to establish the long-term effectiveness. Full article

Objectives: A comprehensive diagnosis and treatment were carried out in 104 newborns, including 48 children diagnosed with unilateral cleft lip and palate (UCLP) and 56 patients diagnosed with bilateral cleft lip and palate (BCLP). The control group consisted of 116 medical records and diagnostic models of jaws from newborns with UCLP/BCLP, which were analysed before and after orthodontic correction using a removable facebow with headgear attachment. Methods: All newborns (n = 104) underwent orthodontic correction to reposition of the alveolar process fragments in UCLP and intermaxillary bone in BCLP using mini-implants and elastic traction devices/springs, followed by primary cheiloplasty. Cheiloplasty was performed one month after fragment alignment had been achieved. Results: Statistical analysis showed that orthodontic correction using mini-implants and elastic traction was highly effective. In the UCLP group, normalised alignment of alveolar fragments was achieved in 97.9% of cases (p = 0.0000000016); in the BCLP group, normalised positioning of the intermaxillary bone was observed in 96.42% (p = 0.00000000007). A direct comparison between the treatment and control groups revealed consistent significance across all diastasis measurements, supporting the clinical advantage of fixed orthodontic approaches. Conclusions: The clinical data and statistical analysis indicate that the fixed orthodontic appliance combined with mini-implants and elastic traction is effective. This approach normalises alveolar and intermaxillary positioning and provides optimal preoperative conditions for primary cheiloplasty and subsequent uranoplasty. It also shortens rehabilitation duration and leads to stable aesthetic and functional results. Full article

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