Search Results (99)

Objective: The present review aims to compare the oral microbial profile (OMP) of patients undergoing fixed orthodontic therapy (OT) versus clear aligner therapy (CAT) for the treatment of malocclusions. Methods: Clinical studies were included. Case-reports/-series, letters to the editor, reviews, perspectives, and expert opinions were excluded. Indexed databases (MEDLINE/PubMed, Embase, Scopus, and Web of Science) were searched up to the end point of May 2025, without time and language barriers. The study was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The risk of bias (RoB) and quality of evidence were assessed. Results: Three randomized clinical trials (RCTs) and seven non-RCTs were included. In all RCTs and five non-RCTs, OMP was assessed using subgingival plaque samples. Periodontopathogenic bacteria and Gram-negative anaerobic microbes were more often identified in patients undergoing fixed OT than CAT. The biofilm mass was higher in patients undergoing fixed OT than CAT. In two RCTs, periodontopathogenic bacteria were dominant among patients undergoing fixed OT than CAT. All RCTs and two non-RCTs had a high RoB. The certainty of evidence was “moderate” in 70% of the studies. Conclusions: Due to a high RoB, variability in study designs, and lack of power analysis, direct comparisons remain limited. 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/Objectives: This study evaluates the diagnostic and referral skills of final-year dental students at Al-Iraqia University using a questionnaire based on malocclusion cases ranging from mild to severe. Methods: The questionnaire, featuring photos and radiographs of five selected treated cases from two textbooks, was answered by 165 students who were asked to assess each case and determine whether orthodontic or surgical treatment was necessary, as well as to identify factors contributing to an unesthetic profile, such as irregular teeth. Frequency distribution and the Chi-square test were used for statistical analysis. Results: The results indicated good overall clinical competence. The unesthetic profile and irregular teeth were the main reasons for referring both Class II and III cases for surgery, with mandibular retrusion being the most common factor in aesthetic concerns. Maxillary protrusion was less frequently selected as a key factor in Class II malocclusion cases. Conclusions: The findings suggest that students demonstrated a high level of diagnostic accuracy in identifying treatment needs for various malocclusion cases. Full article

Background/Objectives: A previous study evaluating convex facial profiles at rest demonstrated that combined orthodontic and orthognathic surgical treatment is more effective in enhancing facial aesthetics compared to orthodontic camouflage alone. The present follow-up study aimed to reassess these findings by incorporating both profile and frontal facial views in the aesthetic evaluation. Methods: This retrospective cohort study sample included 36 consecutively selected patients with convex facial profiles and Class II Division 1 malocclusion. Two groups of 18 non-growing patients with similar characteristics were compared. Group A was treated with orthodontics and orthognathic surgery, whereas Group B was treated with orthodontics exclusively. Pre- and post-treatment profile and frontal facial photographs were simultaneously presented to orthodontists, oral and maxillofacial surgeons, convex profile patients, and laypeople, asking them to assess changes in facial appearance. Results: Significant positive changes in facial appearance were perceived for Group A, in contrast to no changes for Group B, with a difference of 17/100 visual analogue scale (VAS) units. The rater groups demonstrated a high degree of consistency (ICC > 0.88). Multivariate analysis revealed significant differences in perceived changes between the two treatment groups (F = 14.63, p < 0.001, Pillai’s Trace = 0.36, and partial η² = 0.36), with no significant effects from the rater group (p > 0.05). Similar results are evident when only profile photos were rated (p > 0.05). Conclusions: The combined orthodontic and orthognathic surgery approach effectively enhances facial appearance in convex profile cases, whereas orthodontic treatment alone does not result in significant changes. These findings should be clearly communicated during patient consultations and considered in treatment planning. 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 and Objectives: Halitosis is a persistent oral health issue that can undermine self-esteem and social interactions, particularly in younger populations who may be more vulnerable to peer judgment. Orthodontic retainers—both removable and fixed—can alter oral microbiota and salivary parameters, potentially influencing malodor development. This study aimed to compare halitosis severity and oral-health-related quality of life (OHRQoL) in adolescents and young adults (aged 12–25) wearing removable retainers, fixed retainers, or no orthodontic appliances, with an additional focus on salivary pH as a possible modifying factor. Methods: A total of 88 participants were allocated into three groups: removable retainer (n = 28), fixed retainer (n = 30), and no orthodontic treatment (n = 30). Halitosis severity was measured via organoleptic evaluation (0–5 scale) and the Halitosis Associated Life-Quality Test (HALT, 0–100). Salivary pH was determined using a digital pH meter. OHRQoL was assessed through the Oral Health Impact Profile–14 (OHIP-14, 0–56). One-way ANOVA with Tukey’s post hoc test and chi-square analyses were employed to compare outcomes among groups. Spearman’s correlation explored relationships among HALT, organoleptic scores, OHIP-14, and salivary pH. Results: Fixed retainer wearers exhibited higher mean organoleptic scores (2.2 ± 0.6) compared to removable retainer users (1.7 ± 0.5, p = 0.003). HALT results similarly showed that the fixed retainer group (35.6 ± 6.4) reported more halitosis-related burdens than the removable group (31.4 ± 5.9, p = 0.015). Low salivary pH (<6.8) was linked to greater malodor indices in all cohorts (p < 0.05). Correlations revealed moderate positive associations between HALT and OHIP-14 (r = +0.52, p < 0.001). Conclusions: Adolescents and young adults wearing fixed orthodontic retainers reported more severe halitosis and a correspondingly lower oral-health-related quality of life than those with removable retainers or no orthodontic appliances. Salivary pH emerged as an influential factor, indicating that maintaining a neutral oral environment could mitigate malodor. Targeted interventions emphasizing hygiene and saliva management may improve overall well-being in this vulnerable age group. Full article

Orthodontic treatment demand has surged due to heightened aesthetic concerns and the increased recognition of oral health’s role in overall well-being. This systematic review was conducted by searching across multiple databases (PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar) for observational studies published between January 2000 and April 2024 that assessed personality traits using validated instruments, with inclusion criteria focused on outcomes such as pain perception, treatment attitude, compliance, satisfaction, and quality of life. The results consistently indicate that negative personality traits, particularly high neuroticism, are associated with increased pain perception, lower satisfaction, and reduced compliance. In contrast, positive traits, including extraversion, agreeableness, and conscientiousness, were correlated with improved orthodontic outcomes and more favorable treatment attitudes. Additionally, extraversion and openness were observed to moderate the negative impact of malocclusion severity on oral health-related quality of life. When examining gender, overall differences were minimal; however, some studies indicated that females reported slightly higher pain scores. These findings underscore the multifaceted role of personality by suggesting that psychological profiling should be incorporated into clinical practice. By recognizing individual personality profiles, clinicians can tailor treatment approaches to foster patient-centered care, optimizing orthodontic outcomes and enhancing overall patient satisfaction. Full article

Orthodontic treatment is commonly associated with pain, leading to reduced patient compliance and treatment adherence. Non-steroidal anti-inflammatory drugs (NSAIDs) are effective in reducing this pain by inhibiting prostaglandin synthesis. However, this mechanism may also interfere with orthodontic tooth movement (OTM) by affecting bone remodeling. This narrative review investigates the existing literature published between 2004 and 2024 to assess the impact of various NSAIDs on OTM and identify those that balance pain relief with minimal impact on tooth movement. Evidence shows that NSAIDs such as aspirin, ketorolac, diclofenac, and nimesulide significantly reduce OTM. The results for ibuprofen, meloxicam, and celecoxib were inconsistent with both no influence or a reduction in OTM, depending on dosage, mode, and duration of administration. Conversely, tenoxicam, nabumetone, etoricoxib, and parecoxib appear to have no effect on OTM. Among these, etoricoxib appears particularly promising due to its favorable gastrointestinal profile, high COX-2 selectivity, and negligible influence on OTM in clinical doses. However, the limited number of human trials highlights the need for further research to develop evidence-based guidelines for pain management that preserve treatment efficiency in orthodontics. Full article

Objectives: Anterior crowding in the lower jaw is a common orthodontic issue often managed through premolar extraction, which can affect facial profile development. This study aimed to evaluate skeletal and dental changes in moderate to severe crowding using a novel mandibular reference line—the Ramus Anterior Vertical (RaV)—to support treatment planning. Methods: A total of 140 patients (LII > 4 mm and < 9 mm; mean age ≈ 12.5 years) were divided into two groups (G1: extraction; G2: nonextraction; total n = 140; n = 70 per group). Skeletal and dental parameters were measured before (T0) and after (T1) orthodontic treatment using 280 lateral cephalograms. RaV was defined as a vertical line through the anterior ramus point, perpendicular to the occlusal plane. Results: Sagittal measurements relative to RaV were reproducible and unaffected by mandibular mobility. Significant vertical skeletal changes were observed in G2 females, with an increased anterior facial height (N–Sp′ and Sp′–Gn) but a stable Hasund Index. In G1, the dental arch length and distances from RaV to i5 and i6 were reduced, while second molars (i7) remained stable. Sagittal incisor axis changes (L1–NB°, SAi1°) and skeletal–dental correlations (ML–NSL, Gn–tGo–Ar) were present only in G1. Conclusions: RaV proved to be a stable mandibular reference for assessing treatment effects. In this study, premolar extraction vs. nonextraction was comparably effective, though some vertical skeletal adaptations, especially in G2 females, took place. Full article

Orthodontic tooth movement (OTM) is a complex process involving bone remodeling, and is regulated by various molecular factors, including microRNAs (miRNAs). These small, non-coding RNAs are critical in post-transcriptional gene regulation and have been implicated in the modulation of osteoclast and osteoblast activity during OTM. This study aimed to explore the expression profiles of salivary exosome-derived miRNAs during OTM to identify potential biomarkers that could provide insights into the biological processes involved in orthodontic tooth movement. Saliva samples were collected from 15 patients at three time points: before treatment (Day 0), 7 days after the treatment’s onset (Day 7), and 40 days after the treatment’s onset (Day 40). The exosomes were isolated, and the miRNAs were extracted and sequenced. A differential expression analysis and gene ontology (GO) enrichment were performed to identify the miRNAs involved in osteoblast and osteoclast differentiation. Out of the 1405 detected miRNAs, 185 were analyzed. Several miRNAs were associated with bone-remodeling processes. The statistically significant finding was the downregulation of hsa-miR-4634 after 40 days of treatment. These findings contribute to the understanding of miRNA regulation in orthodontics and may have broader implications for skeletal disorders, such as osteoporosis. Full article

Background: The nasolabial angle (NLA) is one of the most critical parameters of the soft tissue profile when orthodontic treatment is required. The primary aim of this prospective cohort study was to compare the differences in the evaluation made on lateral photographs and cephalograms. The secondary aim was to evaluate the modifications of the NLA (nasal and labial components) after orthodontic treatment, including upper first premolar extraction. Methods: The pre- and post-treatment lateral radiographs and profile photographs of 60 subjects (18 male and 42 female) treated with upper premolar extraction and fixed orthodontic appliances were evaluated. The nasolabial angle was measured in both investigations, while cephalometric parameters (skeletal, dental, and soft tissue parameters) were evaluated using lateral radiographs. Results: No statistically significant difference was observed between the results of the two types of measurements on the photographs and radiographs. The soft tissue parameters (ULT and UL-e) showed significant changes after orthodontic treatment, with ULT changing from 21.4 mm ± 4.07 mm to 22.9 mm ± 4.06 mm (p = 0.03) and UL-e changing from 8.42 mm ± 4.84 mm to 10.35 mm ± 4.23 mm (p < 0.001). In patients with thinner lips, the upper lip repositioning was more significant (p = 0.001). No statistically significant difference (p = 0.67) was found between the two evaluation methods. Conclusions: Both cephalometric and photographic evaluations of the nasolabial angle were similar. The soft tissue parameters (ULT and UL-e) showed significant changes after the orthodontic treatment. The repositioning of the upper lip was more acute when the lip thickness decreased. Full article

Backgroud: Orthodontic treatment plans face challenges when deciding on tooth extraction, particularly when the retraction of incisors leads to a flattening of the lip curvature. Despite the significance of this issue, quantitative measurements of curvature have not been previously undertaken. This study presents novel soft tissue measurements, namely SAL (A’toSn-Ls) depth, SAL angle, PBL (B’toLi-Pg) depth, and angle, as tools for assessing lip curvature. The aim of this study was to assess whether new parameters demonstrated more pronounced flattening of the upper and lower lips in the extraction group compared to the non-extraction group. Methods: A total of sixty-two patients diagnosed with skeletal Class I malocclusion and treated with extraction or non-extraction orthodontic treatment were included and compared. Cephalometric measurements were analyzed and compared between the initial and final stages of treatment. Results: The difference in SAL (1.99°) and PBL (4.41°) angles and other soft tissue measurements between the groups was not statistically significant. Multiple regression analysis yielded the equation: ΔSAL = 0.66ΔU1 tip – 0.98ΔL1 tip – 1.58. Conclusions: Flattening of the upper lip was not significantly displayed on moderate anchorage. Consequently, orthodontic treatment accompanying the retraction of the upper incisors does not always result in obtuse lip profiles. Full article

Background: Traditional methods for palatal expansion using fixed appliances often face limitations in comfort and aesthetics. In comparison, aligner therapy has limitations, particularly regarding maxillary expansion. The aim of this study is to examine the biomechanical properties regarding the wire diameter and bending of different stainless steel wires to evaluate their potential for incorporation into maxillary aligner therapy. Materials and Methods: Three rectangular stainless steel wires (0.016″ × 0.022″, 0.017″ × 0.025″, and 0.019″ × 0.025″) were tested for mechanical expansion forces in the intermolar region, comparing non-tooth-shaped bent wires (A groups) and tooth-shaped bent wires (B groups). Using a Z010 testing machine (ZwickRoell GmbH and Co. KG, Ulm, Germany), expansion forces were measured at 1 mm intervals over a 5 mm distance, with 15 samples analyzed per group. Statistical analyses included the Shapiro–Wilk test for normal distribution, the Mann–Whitney U test, which revealed significant results (U = 225, p < 0.001), and the Kruskal–Wallis test, which indicated significance (H = 39.130; df = 2; p < 0.001). Results: Tooth-shaped bent wires exhibited significantly lower expansion forces than non-tooth-shaped bent wires for all tested wire types. This difference was most notable in wires with larger transverse profiles (0.019″ × 0.025″), where the tooth-shaped bent wires displayed a marked reduction in mechanical load capacity. Specific force measurements for non-tooth-shaped wires ranged from 760.61 ± 79.51 mN at 1 mm of deformation to 2468.46 ± 66.27 mN at 5 mm of deformation, while tooth-shaped wires ranged from 116.80 ± 3.74 mN to 1979.49 ± 23.23 mN. Conclusions: These findings suggest that non-tooth-shaped bent wires offer a more efficient and uniform expansion potential for maxillary movements due to their stable elastic properties. Clinically, integrating non-tooth-shaped stainless steel wires into aligner therapy may provide a viable method for maxillary expansion, supporting both first- and second-order movements in orthodontic treatment. Further research is needed to explore the integration of such wires for effective maxillary expansion in aligner therapy. Full article

Background: Temporomandibular disorders (TMDs) represent a range of clinical issues affecting the temporomandibular joint (TMJ), the chewing muscles, and surrounding structures. This study aimed to identify the morphological profiles and skeletal malocclusions that most significantly influence the development of TMDs. Materials and Methods: The analysis was performed using cephalometric data from patients undergoing low-dose cone-beam computed tomography (CBCT) at the Orthodontics Department of Gabriele D’Annunzio University. The Results and Conclusions showed significant differences in cephalometric parameters and condylar positions between male and female patients with TMDs, emphasizing the need for individualized diagnostic and therapeutic approaches. Further research is needed to assess the implications of these variations for TMD management. Full article

Background: The treatment of mandibular second molar (MM2) impaction presents a challenge for orthodontists and requires a surgical–orthodontic approach. This study aims to compare the effectiveness of two techniques for treating impacted MM2: a traditional technique using brass wire and a technique employing skeletal anchorage. Methods: Twelve MM2 with mesio-angular impaction, with an inclination angle between 25° and 40° and an impaction depth between 4 and 10 mm, were selected and randomly divided into two treatment groups. Patients in Group A were treated using the traditional brass wire technique, while those in Group B underwent treatment with a skeletal anchoring technique that utilized a miniscrew positioned in the retromolar region and an elastic sling chain. For both groups, treatment time and the influence of the disimpaction technique on oral health-related quality of life (OHRQoL) were evaluated using the short-form Oral Health Impact Profile (OHIP-14). Results: The results indicated an average treatment time of 168.67 ± 52.32 days for Group A and 76 ± 10.17 days for Group B, with a statistically significant difference (p-value = 0.0002). Regarding the impact on the patients’ OHRQoL, Student’s t-test did not reveal a statistically significant difference between the two groups at 3 and 7 days of follow-up. Conclusions: Both techniques are considered effective for the treatment of impacted MM2 (angulation 25–40°, depth 4–10 mm). The use of skeletal anchorage significantly reduces treatment times without negatively affecting OHRQoL. The results of this study should be confirmed by further studies with larger sample sizes. Full article