Search Results (316)

Background: Objective assessment of preclinical dental practices remains challenging, as it requires consistency, transparency, and standardization in the evaluation of practical competencies. Rubrics have been proposed as useful tools for improving the quality of assessment; however, evidence regarding their psychometric properties in preclinical orthodontic education remains limited. Aim: This study aimed to analyze the reliability, internal structure, and academic usefulness of assessment rubrics applied to preclinical orthodontic practice in undergraduate dental education. Methods: A cross-sectional psychometric retrospective study was conducted with 175 third-year dentistry students enrolled in Orthodontics I at the European University of Madrid. Two analytical rubrics designed to assess wire-bending and cephalometry practices were evaluated. Reliability was assessed using Cronbach’s alpha, construct validity using exploratory factor analysis, and associations with academic performance by correlation analyses. Results: The wire-bending rubric showed moderate internal consistency (α = 0.61), whereas the cephalometry rubric demonstrated adequate reliability (α = 0.71). Exploratory factor analysis yielded evidence consistent with a one-dimensional structure for both instruments. Cephalometry performance was positively associated with theoretical examination scores and seminar performance, whereas no significant associations were observed for wire-bending performance. Students reported generally positive perceptions of rubric use, although lower post-assessment ratings were observed in the wire-bending activity. Conclusions: These findings provide preliminary evidence supporting the reliability and educational usefulness of rubric-based assessment in preclinical orthodontic education. These instruments may contribute to greater transparency and consistency in student assessment. Further studies involving multiple evaluators, multicenter samples, longitudinal designs, and psychometric approaches specifically developed for ordinal data are required. Full article

Orthodontic treatment can be safely performed during pregnancy when tailored to the patient’s hormonal, physiological, psychological, and oral health changes. The study aims to establish a safe, trimester-specific orthodontic practical framework that minimizes maternal–foetal risks while ensuring effective treatment. A modular search on MEDLINE/PubMed (National Library of Medicine, Bethesda, MD, USA) was conducted using combined keywords and subtopic-specific queries to identify relevant literature on orthodontics during pregnancy. Most studies were literature reviews, followed by various observational, survey-based, clinical, and case report designs. Orthodontic care during pregnancy must be adapted to trimester-related risks, with minimal interventions in the first trimester, elective procedures in the second, comfort-focused management in the third, and treatment of complex care postpartum. This protocol requires individual adaptation, highlighting the need for personalized medicine and coordinated input from multiple specialists to address orthodontic, obstetric, and psychological factors during pregnancy. Full article

Background: Infrazygomatic crest (IZC) miniscrews provide reliable extra-alveolar skeletal anchorage for orthodontic tooth movement while minimizing dependence on patient compliance. Although guided insertion techniques have been proposed to improve placement accuracy, freehand insertion remains widely used because of its simplicity and clinical practicality. This retrospective study evaluated the clinical performance and survival of freehand-placed IZC miniscrews over a minimum follow-up period of 30 months. Materials and Methods: A retrospective observational study was conducted on 23 consecutive patients receiving a total of 30 IZC miniscrews between January 2022 and July 2024. All miniscrews were placed freehand by the same experienced orthodontist following individualized radiographic planning based on panoramic radiography and/or cone-beam computed tomography (CBCT), according to the patient’s anatomical requirements. Miniscrews were immediately loaded using light orthodontic forces (<100 g), with progressive force increases during subsequent appointments based on treatment objectives. Patients were reviewed at approximately 30–35-day intervals. Clinical records were analyzed to assess miniscrew survival, timing of failure, and procedure-related complications using descriptive statistical analysis. Results: Twenty-seven of the 30 miniscrews remained clinically stable throughout treatment, corresponding to an overall success rate of 90.0%. Three failures occurred during the early treatment phase, while no late failures were observed. Because of the limited number of failure events, potential contributing factors—including screw dimensions, mechanical interference, and deterioration of oral hygiene during treatment—were evaluated descriptively and should be interpreted with caution. No major surgical or radiographic complications were detected during follow-up. Conclusions: Within the limitations of this retrospective observational study, freehand placement of IZC miniscrews demonstrated favorable clinical performance when performed by an experienced operator following appropriate radiographic planning. However, the relatively small sample size, absence of a control group, and descriptive nature of the analysis preclude definitive conclusions regarding factors influencing miniscrew failure or the comparative effectiveness of freehand versus guided insertion. Larger prospective controlled studies are warranted to validate these preliminary findings. Clinical relevance Manual IZC miniscrew insertion represents a predictable, efficient, and cost-effective alternative to guided approaches in orthodontic practice. Full article

Orthodontic adhesives can accumulate biofilm, which may lead to long-term white-spot lesions; however, incorporating poly (lactic-co-glycolic acid) (PLGA) nanoparticles could improve their anticariogenic properties. Objective: To develop PLGA nanoparticles containing antiseptic agents for orthodontic adhesives, improve antibacterial activity against Streptococcus mutans, and assess cytotoxicity in gingival fibroblasts. Methods: PLGA nanoparticles with chlorhexidine and chitosan were synthesized and characterized using FTIR, SEM, and UV-Vis spectroscopy. Antibacterial activity was evaluated by agar diffusion and microdilution assays, and cytotoxicity and microhardness were also assessed. Results: PLGA-NPs showed moderate antibacterial effects, with inhibition rates from 74.25% to 54.05% in agar diffusion and reduced activity in microdilution (CC50: 3.75 µg/mL in adhesive, 15 µg/mL free). PLGA-NPs-CHx exhibited stronger antibacterial activity, with inhibition ranging from 89.38% to 73.75% and a CC50 of 0.93 µg/mL in both forms. PLGA-NPs-CH also showed significant inhibition (83.11% to 69.39%) and a CC50 of 1.87 µg/mL in adhesive and 7.5 µg/mL free. Vickers microhardness values were similar across groups: 74.67 HV for adhesive only, 74.11 HV for adhesive with PLGA-NPs, 74.22 HV for PLGA-NPs-CH-Adh, and 74 HV for PLGA-NPs-CHx-Adh. Conclusions: Incorporating PLGA nanoparticles functionalized with antiseptic agents into orthodontic adhesives shows promising antibacterial potential and may benefit orthodontic practice. Full article

Background/Objectives: Automatic three-dimensional (3D) cephalometry on cone beam computed tomography (CBCT) is increasingly used in orthodontic and orthognathic practice, but whether fully automatic systems reproduce bilateral measurements with equal fidelity on both sides, and whether the right–left difference they report can be trusted as a clinical measure of asymmetry, has not been studied systematically. This study aimed to quantify side-specific agreement and asymmetry quantification fidelity of two commercial AI cephalometry systems against calibrated manual 3D tracing. Methods: Thirty-one CBCT scans were analysed by calibrated manual tracing (InVivo software), an integrated AI module (AI InVivo), and a cloud-based system (Diagnocat). Side-specific agreement was quantified using the two-way random effects intraclass correlation coefficient [ICC(2,1)], Bland–Altman analysis, and two one-sided equivalence tests (±2°/±2 mm). Asymmetry fidelity was assessed by ICC of the automatic right–left difference (Δ = R − L) against the manual Δ, Pearson correlation, and sensitivity/specificity for detecting clinically relevant asymmetry. Results: Per-side agreement closely mirrored overall accuracy; any systematic error was applied almost equally to both sides (bias difference ≤0.3° or ≤0.9 mm between sides). The mandibular plane angle achieved excellent ICC (0.95–0.97) and equivalence on both sides for both systems. The gonial angle was equivalent for AI InVivo (ICC 0.92–0.93) but not for Diagnocat (ICC 0.40; bias −6.95° and −6.97° on the right and left, respectively). Asymmetry agreement was generally weaker than per-side accuracy. Diagnocat showed no correlation with manual gonial asymmetry (ICC −0.12), while AI InVivo demonstrated poor agreement for body length asymmetry (ICC 0.18). Both systems under-detected clinically relevant gonial asymmetry (sensitivity 0.00–0.17), with errors predominantly in the false-negative direction. Conclusions: Fully automatic AI-powered 3D cephalometry applies systematic errors symmetrically to both sides, so per-side accuracy holds equally for right and left measurements. However, asymmetry fidelity is a separate, more demanding property that does not follow from absolute accuracy and remains unreliable for landmark-sensitive parameters such as the gonial angle. Clinician verification is required before automatic analysis is used for asymmetry assessment. 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: Malocclusion has important functional, esthetic, and psychosocial consequences; however, access to orthodontic treatment remains uneven and strongly influenced by socio-economic factors. While these disparities are well documented internationally, evidence from Romania remains limited. This study aimed to evaluate the influence of socio-economic factors on orthodontic treatment initiation within the Romanian population. Methods: A cross-sectional questionnaire-based study was conducted in 2025 using an online survey distributed through social media and community networks. A total of 285 adults were included. Data were analyzed using descriptive statistics, chi-square tests, and multivariable logistic regression. Results: Overall, 56.5% of respondents reported having undergone orthodontic treatment. Age and self-perceived information level were significantly associated with treatment initiation in the multivariable model. Participants older than 30 years were significantly less likely to have undergone orthodontic treatment compared with those aged 18–30 years (OR = 0.28, 95% CI: 0.12–0.62, p = 0.002). Higher levels of self-perceived information were associated with a greater likelihood of having undergone orthodontic treatment (OR = 0.75, 95% CI: 0.59–0.96, p = 0.020). Income and area of residence were not significantly associated with treatment initiation. However, respondents with lower income levels were significantly more likely to perceive treatment cost as a barrier to orthodontic care. Conclusions: Within this surveyed sample, age and self-perceived information level were independently associated with orthodontic treatment initiation. Although income was not associated with treatment uptake, financial cost remained an important perceived barrier, particularly among lower-income respondents. Given the convenience sampling strategy and limited representativeness of the sample, the findings should be interpreted as exploratory and require confirmation in larger population-based studies. Full article

Background: Childhood oral hygiene behaviors are crucial to preventing oral diseases and can influence the development and progression of malocclusions. The World Health Organization (WHO) Oral Health Questionnaire is a standardized tool for assessing oral hygiene behaviors, oral health-related behaviors, and preventive dental awareness in children. Aim: This study aimed to assess oral hygiene behaviours and examine associations between WHO Oral Health Questionnaire variables and Angle malocclusion classes among children aged 6–9 years. Materials and Methods: This cross-sectional study included 90 children aged 6–9 years from the Pristina region, Kosovo. Data were collected using the WHO Oral Health Questionnaire for Children, which assessed oral hygiene habits, toothbrushing frequency, fluoride awareness, dental attendance, dietary behaviors, oral symptoms, and oral-health-related quality of life. Malocclusion was classified according to Angle classification into Class I, II, and III malocclusions with 3D intraoral scanners, Aerolscan 3. Descriptive statistical analysis, Chi-square (χ²) test, Spearman correlation analysis, and reliability analysis using Cronbach’s Alpha were performed using SPSS Statistics 23.0 (IBM Corp., Armonk, NY, USA) and Statistica 7.1 (StatSoft Inc., Tusla, OK, USA). Results: Most participants reported regular oral hygiene practices, with 46.7% brushing their teeth two or more times daily. However, limited awareness regarding fluoride-containing toothpaste was observed, as most children answered “don’t know” regarding fluoride use. Occasional toothache or oral discomfort was reported by 33.3% of participants, while 23.3% reported dissatisfaction with dental appearance. Difficulty biting hard foods was present in 34.4% of children. Reliability analysis of the Q10 section demonstrated moderate internal consistency (Cronbach’s Alpha = 0.500). Chi-square analysis demonstrated no statistically significant association between Angle malocclusion classes and WHO questionnaire variables (p > 0.05). The highest χ² value was observed for tooth-cleaning frequency (Q7) (χ² = 11.97; p = 0.152), although the association remained statistically non-significant. Psychosocial impact questions and oral health-related quality of life questions also demonstrated no statistically significant association with malocclusion classes. Conclusions: oral hygiene practices, preventative oral health practices, and oral health-related experiences were comparatively similar among children in different Angle malocclusion classes. Although there were no statistically significant correlations found between malocclusion classes and WHO questionnaire variables, the results show that some children have psychosocial concerns about their dental appearance and insufficient awareness of preventive oral health. The WHO Oral Health Questionnaire is a useful epidemiological tool for evaluating pediatric oral health behaviors and may help build youth orthodontic and preventive oral health policies. Full article

Prolonged use of clear aligners promotes bacterial colonization and biofilm formation, which can compromise orthodontic outcomes. There is a clear clinical demand for approaches that can suppress pathogenic activity while preserving the fundamental functional and material characteristics of the aligners. To address this need, a novel strategy of fabricating metal–organic framework (MOF) coatings on aligners was adopted. Metal–organic frameworks (MOFs) have emerged as promising antibacterial coating materials by combining antimicrobial metal ions with biocompatible organic ligands. Three distinct porphyrin-based MOFs (Ag-, Cu-, and Ce-TCPP) were synthesized and fabricated as coatings on clear aligner surfaces via a coordination-driven self-assembly approach. The coated aligners were comprehensively assessed in vitro to determine their antibacterial performance, anti-inflammatory potential, biocompatibility, and key physical characteristics. Among the three coatings, Ag-TCPP showed the most favorable overall antibacterial and anti-biofilm performance in the present experimental system and facilitated macrophage polarization toward an anti-inflammatory M2-like phenotype. Ag-TCPP exhibited a significant inhibition zone of 6.75 ± 0.25 mm and reduced biofilm biomass by 72.2%. All MOF coatings exhibited excellent biocompatibility, and their application did not compromise the aligners’ mechanical integrity or aesthetic properties (light transmittance). This study reports the successful development of a novel metal–organic framework (MOF)-based coating strategy for clear aligners. Among the formulations investigated, the Ag-TCPP coating exhibited outstanding antibacterial and immunomodulatory performance while maintaining the critical mechanical integrity and aesthetic qualities of the aligner. The findings of this work offer a practical approach to designing multifunctional orthodontic devices that may reduce biofilm-related complications and improve clinical outcomes. Full article

Background: Aligner workflows range from outsourcing the design and manufacturing process to in-office scanning, planning, and fabrication. This exploratory retrospective study aimed to evaluate whether discrepancies between planned and achieved anterior tooth movements with SureSmile aligners remain within predefined clinical thresholds. Methods: A total of 21 dental arches from 14 patients who underwent SureSmile aligner treatment with in-office fabricated aligners were retrospectively analyzed. Digital models of the planned setup were superimposed on models of the clinically achieved outcomes to assess the accuracy of anterior tooth movements by comparing planned and clinically achieved outcomes. Results: Rotational movements showed larger discrepancies than translational movements. Mean discrepancies for angulation and axial rotation were 3.42 ± 1.50° and 4.50 ± 2.12°, respectively, both exceeding the predefined clinical threshold of 2°. In contrast, translational discrepancies remained below the clinical threshold of 0.5 mm, with mean values of 0.17 ± 0.11 mm for mesiodistal, 0.27 ± 0.16 mm for labiolingual, and 0.38 ± 0.17 mm for vertical movements. Translational discrepancies were significantly lower than the predefined clinical threshold in patient-level analyses, whereas rotational discrepancies were not. Conclusions: In-office SureSmile aligner workflows showed acceptable accuracy for translational anterior tooth movements, whereas angular movements frequently exceeded predefined clinical thresholds. Full article

Background/Objectives: Orthodontic treatment induces controlled mechanical forces that alter the periodontal environment, including changes in oral microbiota composition and activation of local inflammatory pathways. Despite the widespread and growing use of orthodontic appliances across all age groups, the magnitude, timing, and multi-domain biological impact of these changes have not been comprehensively quantified in a single systematic synthesis. This systematic review and meta-analysis aimed to synthesize the available evidence on periodontal clinical parameters, oral microbiota composition, and local inflammatory biomarkers associated with orthodontic treatment using fixed appliances and clear aligners, and to provide a structured, GRADE-rated evidence base for clinical practice. Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines. PubMed/MEDLINE, Scopus, and Web of Science were searched from inception to March 2026. Prospective cohort studies, longitudinal clinical studies, and randomized controlled trials evaluating periodontal parameters, oral microbiota, and inflammatory biomarkers during orthodontic treatment were included. Quantitative synthesis was performed using mean differences or standardized mean differences with 95% confidence intervals, primarily assessing within-group (pre–post) changes. Results: Eighteen studies (n = 812 patients; follow-up 3–12 months) met inclusion criteria. Fixed orthodontic appliances were consistently associated with transient increases in plaque index (MD 0.45, 95% CI 0.32–0.58; I² = 62%), gingival index (MD 0.38, 95% CI 0.25–0.51; I² = 55%), and bleeding on probing (MD 15.2%, 95% CI 10.1–20.3%; I² = 48%), particularly during early treatment phases. Microbiological analyses demonstrated within-group shifts toward increased prevalence of periodontopathogenic species (Streptococcus mutans OR 2.45, 95% CI 1.89–3.18; Porphyromonas spp. OR 2.14, 95% CI 1.67–2.75) in patients treated with fixed appliances. Local inflammatory responses were characterized by elevated IL-1β (MD 1.2, 95% CI 0.8–1.6) and IL-6 (MD 0.9, 95% CI 0.6–1.2) in gingival crevicular fluid. Certainty of evidence was rated moderate for plaque and gingival indices and low for microbiological and inflammatory outcomes (GRADE). Conclusions: Orthodontic treatment—particularly with fixed appliances—is associated with transient, reversible deterioration of periodontal indices, shifts toward a more dysbiotic oral microbiome, and elevation of local inflammatory mediators in gingival crevicular fluid during active treatment phases. These changes are manageable through structured preventive protocols and regular periodontal monitoring. Future prospective studies with concurrent control groups and standardized multi-domain outcome measures are needed to better define the magnitude and reversibility of these biological responses. PROSPERO: CRD420261336117. Full article

Background/Objectives: Changes in the mechanical behavior of orthodontic archwires during clinical use are not fully understood, particularly when different bracket systems are employed. Self-ligating (SL) brackets have gained considerable popularity in orthodontic practice in recent years, largely due to claims of improved treatment efficiency and biomechanical performance. Nevertheless, current evidence has not consistently demonstrated statistically significant differences between conventional ligation (CL) brackets and SL systems. The aim of this study was to evaluate changes in the mechanical properties and degradation over time of nickel-titanium (NiTi) archwires after clinical use in orthodontic treatments performed with CL and SL brackets. Methods: A comparative study was conducted using archwires retrieved from orthodontic patients. Round 0.014-inch NiTi wires (GC Orthodontics America Inc., IL, USA) were analyzed. The archwires were used in 60 patients treated with either CL or SL appliances and evaluated at four time points: before clinical use (T0), and after 1 month (T1), 2 months (T2), and 3 months (T3) of intraoral service. Mechanical testing was performed according to ISO 15841:2014 + Amd. 1:2020 using a three-point bending test with a universal testing machine (Z005 Test Control II Universal Testing Machine, Zwick Roell, Kennesaw, GA, USA). The variables analyzed included the mean force delivered by the archwires at deflections of 3 mm (F3), 2 mm (F2), 1 mm (F1), and 0.5 mm (F0.5), as well as the slope of the superelastic plateau at 2 mm, 1 mm, and 0.5 mm. The static and dynamic friction coefficients, as well as the friction forces associated with the wires and the two types of brackets, were determined using a modified MTS-Bionix servo-hydraulic testing machine. The tests were conducted at 37 °C in a saline environment. Results: Both groups showed changes in the superelastic behavior of NiTi archwires. Alterations increased with longer intraoral exposure. In the SL group, significant modifications were already observed after one month of clinical use, with a reduction in the force delivered and a loss of superelastic characteristics. These changes remained relatively stable thereafter, with no statistically significant differences during the following months. In contrast, the CL group showed a progressive reduction in force delivery and superelasticity over time. This is due to the difference in friction between the wire and the CL bracket compared to the SL bracket, which results in greater force transfer for tooth movement. Conclusions: Overall, differences in the mechanical behavior of archwires between CL and SL systems were observed during the initial stages of clinical use. However, these differences diminished over time, and no significant differences were detected after three months. Considering the progressive degradation of mechanical properties, the reuse of archwires that have remained intraorally for more than three months may not be advisable. Full article

Background/Objectives: Systematic assessment of orthodontic treatment needs is essential for prioritizing care in public health programs. The Dental Aesthetic Index (DAI) provides a composite severity score; however, understanding which individual occlusal traits drive severe treatment needs has a practical screening value. This study aimed to determine which occlusal features, categorized using established clinical thresholds, independently associated with severe orthodontic treatment need. Methods: Pretreatment records of 292 patients (141 men, 151 women; aged 13–42 years) were analyzed. The outcome was severe treatment need (DAI ≥ 31). Ten DAI components were categorized using IOTN-DHC severity cutpoints; Angle and skeletal classifications were also assessed. Candidate predictors (p < 0.20) were entered into multivariate logistic regression with backward elimination. Discrimination was assessed by ROC analysis; internal validation used bootstrap resampling and cross-validation. Results: Of the 292 patients, 141 (48.3%) had severe treatment needs. Six occlusal features were independently associated with severe treatment need (all p < 0.001): overjet severity (adjusted odds ratio [OR] = 412.4; 95% confidence interval [CI]: 82.1–2072.1), missing anterior teeth (OR = 29.3; 95% CI: 8.6–99.5), open bite severity (OR = 13.4; 95% CI: 4.6–39.5), diastema (OR = 7.4; 95% CI: 2.4–22.5), molar cusp relationship (OR = 4.7; 95% CI: 2.3–9.5), and anterior spacing (OR = 2.9; 95% CI: 1.5–5.4). The area under the ROC curve was 0.971 (optimism-corrected: 0.968), and 90.8% of the patients were correctly classified by the final model (sensitivity, 89.4%; specificity, 92.1%). Angle classification, skeletal classification, sex, age, and crowding were not included in the final model. Conclusions: Six clinically categorized occlusal features assessed by visual inspection were independently associated with severe orthodontic treatment need in this explanatory analysis, with overjet severity as the dominant determinant. Categorical severity grades based on established clinical thresholds retained strong discriminative information (optimism-corrected AUC = 0.968), suggesting that simplified assessments may be sufficient for the initial screening. Dental and skeletal classifications did not provide an independent predictive value beyond that of occlusal features. External validation is needed before clinical implementation. Full article

Background/Objectives: Orofacial myofunctional therapy (OMT) is a system of targeted neuromuscular exercises and behavioral retraining intended to optimize tongue, lip, jaw, and airway function during rest, breathing, swallowing, and sleep. Historically associated with tongue thrust and abnormal swallowing, OMT is now applied across an expanding range of clinical contexts, including sleep-disordered breathing (SDB), tongue-tie rehabilitation, orthodontic stability, and perioperative functional recovery. As its use has broadened, persistent questions have followed: what is myofunctional therapy, where did it originate, and how did a set of oral exercises evolve into an intervention increasingly integrated with airway health, sleep medicine, and surgical care? Methods: This article presents a narrative historical review with a perspective component, synthesizing foundational literature, interdisciplinary contributions, and selected contemporary evidence to examine the evolution of OMT from ancient functional practices to modern clinical science. It is written to trace recurring clinical observations, shifts in educational frameworks, and key inflection points that shaped how OMT has been taught and applied over time. Results: OMT did not emerge from randomized controlled trials or standardized protocols. It arose from repeated clinical encounters with patients with atypical craniofacial development, relapse of structural correction, persistent mouth breathing, and/or unresolved swallowing and speech dysfunction despite technically successful treatment. These patterns suggested that anatomy alone could not account for outcome variability. Over time, clinical attention expanded beyond isolated tongue function to include breathing patterns, posture, neuromuscular tone, and airway behavior. In the past two decades, controlled trials, cohort studies, and systematic reviews have supported selected applications of OMT, particularly in SDB and adjunctive airway care, while also revealing ongoing challenges related to training variability, terminology, scope of practice, and standardization. Conclusions: OMT has historically been described as a system of targeted neuromuscular and behavioral interventions aimed at modifying orofacial rest posture and function. Over time, the field has expanded beyond localized muscle retraining toward a broader functional framework that integrates airway physiology, craniofacial growth, sleep, and interdisciplinary rehabilitation. Full article

Background: Daily, perhaps for hours at a time, pacifiers are put in baby’s mouths for the primary purpose of soothing. A causal relationship exists between the use of pacifiers and the development of malocclusions and disturbances to the cranio-facial-respiratory complex (CFRC). Finite element analysis (FEA) has enabled us to understand how pacifier bulbs behave under negative pressure and tongue movement in the mouth. It is now realized that the design and size of pacifiers should be based on infant and toddler biometrics of the maxillary palatal width and should contribute to proper oral function and development. Attention has shifted toward the interaction between the pacifier shield, the lips, chin and developing tempro-mandibular joint (TMJ). Free mandibular motion is essential to normal TMJ development, essential to maintaining airway space and promoting forward mandibular growth. This is especially relevant in infants with retrognathia, when shield pressure may restrict free movement of the jaw and anterior mandibular advancement. Conclusions: When the pacifier shield interacts with the chin, it impacts the growth and development of the infant mandible and airway physiology. Interference with free movement of the mandible must be made a functional concern in design of the pacifier shield. Technological advances in smartphone photogrammetry now make development of non-invasive diagnostic tools that can advantage the future oral health of children. Full article