Search Results (1,471)

Background/Objectives: The accelerated digitalisation of dental practice is significantly influencing how patients perceive and accept modern treatments. This study uses a structured questionnaire to evaluate patients’ knowledge of, and attitudes towards, digital technologies in dentistry, adopting an original, patient-centred perspective within routine clinical settings. Methods: Non-parametric statistical methods (Mann–Whitney U test, Kruskal–Wallis H test and Spearman correlations) were employed to analyse the responses of 397 participants. To reduce selection bias, a systematic sampling technique was employed, and thorough validation ensured the consistency of the instrument. The questionnaire covered socio-demographic information, prior dental experience and opinions regarding specific digital applications (intraoral scanning (IOS), cone-beam computed tomography (CBCT), CAD-CAM workflows, 3D printing). Knowledge was operationalised as awareness; no keyed objective knowledge test was administered. Results: The findings show that patients generally accept digital technologies, with perceptions of costs, prior experience of digital dental procedures and educational level having a significant impact. The duration of the patient–clinician relationship, the patient’s dental health, and the history of orthodontic and prosthetic procedures also impacted the acceptance of digital technologies. Notably, clinical staff members were the main source of information, highlighting the importance of professional–patient communication. Conclusions: The results highlight the importance of patient-friendly communication in healthcare and provide a solid basis for the implementation of patient-centred digital dentistry. Future plans should focus on creating specialised educational materials, improving digital literacy, and promoting equal access to cutting-edge technologies in urban and disadvantaged communities. Full article

Introduction: Infrared thermography (IRT) is a non-invasive, non-ionizing imaging modality capable of rapidly capturing surface temperature variation. In dentistry, particularly orthodontics and TMD evaluation, IRT may serve as a valuable complementary tool to be added in conventional diagnostic protocols. Objective: Correlate possible relationships between thermographic findings of orofacial structures and cephalometric landmarks. Methods: An infrared imaging camera, FLIR^® i7, was used to record the regions of interest, correspondent to the temporal, masseter and orbicular oris muscles, in adolescents (n = 22). Bilateral temperature differences were considered as thermal asymmetries with a conventional threshold of 0.3 °C to distinguish an eventual hyperactivity or hyperfunctions of detrimental structures. The Trevisi cephalometric parameters that were taken into consideration for the study were SNA, SNB, ANB, OccltoSn, Wits relation to base and Molar/canine classes. Results: Most of the participants showed a normal temperature difference ΔΤ for the upper and lower orbicular oris muscle, right vs. left, 96% and 92%, respectively. The other ROIs presented a mixed pattern of thermal asymmetries; however, no statistically significant differences were found when crossed with the cephalometric landmarks. Conclusions: Asymmetrical patterns of infrared thermography can aid on the diagnosis and treatment plan of an orthodontic appointment, since the actual stability of pos-orthodontic treatment is highly dependent on the muscular activity of the tongue and lips, in particular when the patient has atypical swallowing. Our findings suggest that this technique can be used to quantify anatomical landmarks relevant to craniofacial morphology in specific populations, particularly at ages where muscular functional activity is strongly correlated with dentoskeletal development. Full article

Background/Objectives: The aim of this study was to evaluate the accuracy of aesthetic assessments performed by artificial intelligence (AI)-based large language models (LLMs) using the Aesthetic Component of the Index of Orthodontic Treatment Need (IOTN-AC), which is widely applied to determine the need for orthodontic treatment. Methods: A total of 150 frontal intraoral photographs from patients in the permanent dentition, scored from 1 to 10 on the IOTN-AC, were assessed by two AI-based LLMs (ChatGPT-5 and ChatGPT-5 Pro). Two experienced clinicians independently scored all photographs, with one evaluator’s scores used as the reference (κ = 0.91, ICC = 0.88). Model performance was analyzed by comparing IOTN-AC scores and treatment need classifications. In addition, performance parameters such as accuracy, precision, specificity, and sensitivity were evaluated. Statistical analyses included Spearman correlation, Cohen’s Kappa, ICC, Mean Absolute Error (MAE), Wilcoxon signed-rank test, and Bland–Altman analysis. Results: Both models demonstrated positive and significant correlations with the reference values for scoring and classification (p < 0.001). Compared to GPT-5 Pro, the GPT-5 model exhibited superior performance, with a lower error rate (MAE = 1.47) and higher classification accuracy (66.7%). Bland–Altman analysis showed that most predictions fell within the 99% confidence interval, and regression analysis revealed no systematic bias (p > 0.05). Conversely, the models failed to achieve consistently high performance in each of the performance parameters. Conclusions: The findings revealed that although AI-based LLMs are promising, statistical accuracy alone is insufficient for safe clinical use, and they should demonstrate consistently high performance across all parameters. Full article

Effective medical waste planning relies on the reliable estimation of waste volumes. As operational factors diversify, traditional linear regressions often fail to capture the underlying structure, whereas latent variable–based and ensemble approaches can better represent this complexity. In this study, fine-tuned Partial Least Squares (PLS), scikit-learn–based Gradient Boosting regression (GBR), and a baseline Ordinary Least Squares (OLS) model were compared for estimating medical waste generation using 48 months (2021–2024) of approximate data from Dental Clinics affiliated with the Provincial Health Directorate in Kastamonu. The model inputs were the monthly procedure counts for endodontics, treatment, prosthetics, periodontology, orthodontics, pedodontics, and surgery. Performance was evaluated using Root Mean Square Error (RMSE), Mean Absolute Error (MAE) and R-squared (R²). All models produced accurate predictions; however, PLS provided the strongest fit (R² = 0.979; MAE = 30.488; RMSE = 37.043), outperforming GBR (R² = 0.962; MAE = 36.544; RMSE = 48.990) and the OLS baseline (R² = 0.927; MAE = 41.762; RMSE = 59.013). The findings demonstrate that modern, data-driven waste-management planning is feasible in healthcare institutions and highlight PLS as a robust option, particularly under conditions of small sample size and collinearity. Full article

Introduction: Orthodontic practice, though often considered low-risk compared with other dental specialties, is increasingly exposed to medico-legal challenges shaped by the volatile, uncertain, complex, and ambiguous (VUCA) environment of modern healthcare. The aim of this review was to identify the underlying causes and typologies of malpractice claims in orthodontics. Methods: This narrative review synthesizes evidence from 2010–2024 on malpractice allegations and risk management strategies in orthodontics, with attention to the clinical, ethical, and legal dimensions. Results: The analysis of the included articles identified the most common types of malpractice allegations and the share of malpractice allegations of orthodontists in relation to other specialties; the main risks of orthodontic practice were identified, as well as risk management strategies in orthodontics. The findings highlight that most malpractice allegations are not related to medical/clinical errors, but to ethical–legislative, behavioral/relational, and perceptual/aesthetic vulnerabilities. Conclusions: This review highlights the need for physicians to focus on the acquisition of transversal skills, to have the ability to understand, adapt and respond to the rational and emotional needs of patients. This is essential in an ever-changing world, supporting healthcare professionals in maintaining professional safety. This review opens a relevant research direction on the role and impact of digital technology in the orthodontist–patient relationship, having the ability to influence the dynamics of this therapeutic relationship and the perception of the treatment outcome. Full article

Introduction: The aim of this study was to evaluate the effect of corticotomy incision depth on tooth movement and stress distribution in the periodontal ligament (PDL) during orthodontic expansion using finite element analysis (FEA). The demand for accelerated and biologically safe orthodontic techniques has highlighted the importance of understanding biomechanical responses to surgical adjuncts like corticotomy. Objective: The aim of this study is to assess the effect of corticotomy depth on tooth movement and periodontal ligament stress distribution during orthodontic treatment using finite element analysis. Materials and methods: A 3D FEM model was developed based on CBCT and intraoral scans to replicate anatomical structures and simulate clinical orthodontic scenarios. Four conditions were analyzed: no corticotomy and corticotomy incisions of 1 mm, 2 mm, and 3 mm depths, applied between roots and above the apex region. Different cortical bone densities were tested using Young’s modulus values (12,500 MPa–27,500 MPa). Stress and displacement values were measured in both the crown and root regions. Results: The 3 mm corticotomy, penetrating through the cortical plate into the cancellous bone, significantly increased crown displacement (up to 26% in low-density bone) and altered root tipping patterns, reducing root movement relative to the crown. Shallower incisions (1–2 mm) had minimal effects. Despite increased movement, stress concentration in the cervical PDL region remained high across all scenarios, particularly in the premolar area, exceeding the 4.7 kPa threshold associated with tissue ischemia. Conclusions: Corticotomy depth is a critical factor for optimizing orthodontic tooth movement. Penetration into cancellous bone (3 mm) appears necessary to induce both: not only the Regional Acceleratory Phenomenon (RAP) but also to enhance displacement. However, this approach does not significantly reduce cervical PDL stress and offers limited periodontal protection. Individual planning based on bone density, morphology, and anatomical limitations is essential for balancing treatment efficiency and periodontal safety. Full article

Continuous use of clear aligners modifies the oral environment and may favor bacterial colonization. Integration of topical fluoride-based agents could strengthen enamel and reduce biofilm formation. This study evaluated the effects of a galenic fluoride-mint spray (225–250 ppm fluoride and 1–2% peppermint essential oil) on salivary fluoride concentration and bacterial biofilm during orthodontic treatment. Ten patients using 3D-printed nighttime aligners were enrolled. Saliva samples were analyzed with an ion-selective electrode (ISE) at baseline, immediately after inserting the sprayed aligners and after 15, 30, 45 min post application. Biofilm morphology was qualitatively assessed by scanning electron microscope (SEM) in three aligners: unused, worn 14 nights without spray, worn 14 nights with spray. Salivary fluoride increased from 0.7–0.8 mg/L at baseline to 5.96 mg/L when the spray was applied on a new aligner and 8.42 mg/L on a used aligner, then progressively decreased, returning close to baseline at 45 min with the new aligner and remaining higher with the used aligner. SEM images showed mature and heterogeneous biofilm on used aligners without the spray, while aligners with nightly spray application exhibited qualitatively reduced and less organized surface deposits. The fluoride- and mint-based spray rapidly increases salivary fluoride and reduces biofilm formation on nighttime clear aligners, improving preventive oral health during orthodontic treatment. Full article

Background/Objectives: Accurate assessment of craniofacial morphology is essential for orthodontic diagnosis and treatment planning. The Sassoni classification provides a useful framework for categorizing craniofacial morphology into nine groups but lacks standardized clinical criteria. This study developed an AI model to classify pediatric craniofacial morphology based on the Sassoni classification using lateral cephalometric radiographs and evaluated its agreement with classifications made by orthodontists. Methods: Data from 300 pediatric patients aged 6 to 10 years were analyzed. Nine cephalometric measurements and patient gender were used as input features. Three orthodontists classified morphology based on the Sassoni classification. Random forest (RF), logistic regression (LR), and support vector classification (SVC) models were trained and evaluated using 10-fold cross-validation. Results: The Random Forest (RF) model demonstrated the highest accuracy (RF: 0.907 ± 0.051, LR: 0.837 ± 0.057, SVC: 0.770 ± 0.055). It also outperformed the other two models in terms of F1 score, sensitivity, and positive predictive value, showing the best overall classification performance. The most influential feature was the ANB angle, while gender had minimal impact. Conclusions: The RF-based AI model demonstrated high accuracy in pediatric maxillofacial classification. Performance may be further improved with larger datasets and more balanced case distributions. Full article

Background: Amelogenesis imperfecta (AI) includes a group of inherited disorders that affect enamel formation, both in quality and quantity. It may cause anomalies in a number of teeth or a group of teeth, or it may be present in the whole dentition. The main complaints of patients who are affected by AI are increased sensibility to hot and cold food, impaired esthetic appearance, discoloration of mandibular and maxillary anterior teeth, and masticatory problems. The treatment of adult patients with amelogenesis imperfecta usually demands a multidisciplinary approach because several problems are present. Pediatric treatment is usually undertaken at an early stage, and orthodontic treatment usually begins in adolescence. Periodontal and prosthetic treatments are usually required for the rehabilitation of patients who usually have been expecting this treatment for years. Objective: The aim of this case report is to present a full mouth rehabilitation with all-ceramic restorations in a young patient with amelogenesis imperfecta, with follow-up at 10 years. Treatment: An 18-year-old with amelogenesis imperfecta presented for functional and esthetic rehabilitation. The patient underwent a second orthodontic treatment, conservative periodontal therapy, and restored with all-ceramic restorations. Results: The patient was fully satisfied with the outcome of the therapy, and the clinical situation remained stable at 10-year recall. Conclusions: All-ceramic restorations can be a clinically acceptable option for the rehabilitation of patients with amelogenesis imperfecta. Full article

Objective: To evaluate changes in maxillary incisor inclination before and after orthodontic treatment in adults with different vertical facial patterns (normodivergent, hypodivergent, hyperdivergent) and to assess the relationship of incisor inclination to facial and growth axes using cephalometric and photographic records. Materials and Methods: This retrospective study included 144 non-growing patients (96 females, 48 males) with available pre- and post-treatment lateral cephalograms and smiling profile photographs. Patients were classified into three groups based on mandibular plane angle (MP/SN): normodivergent (n = 66), hypodivergent (n = 35), and hyperdivergent (n = 43). Angular measurements assessed maxillary incisor inclination and growth/facial axes. Clinical crown angulation (CCA) was evaluated from profile photographs. Statistical analyses included paired t-tests, ANOVA with Bonferroni post hoc tests, and Pearson correlation. Results: No significant changes in maxillary incisor inclination were observed post-treatment in any of the groups. Significant skeletal changes were noted in the hypodivergent group, including increases in MP/SN (p = 0.011) and IMPA (p = 0.014). Intergroup comparison revealed significant differences in changes in Facial Axis/H (p = 0.020) and MP/SN (p = 0.025). Correlations between CCA and skeletal axes were more pronounced in normo- and hypodivergent groups, while hyperdivergent patients showed no significant associations. Conclusions: These findings suggest that the stability of maxillary incisor inclination reflects controlled torque mechanics during treatment. In normo- and hypodivergent patients, skeletal axes may help guide esthetic incisor positioning; however, in hyperdivergent patients, soft tissue and smile evaluation should play a greater role when determining final incisor inclination. Full article

Background/Objectives: Assessment of the midpalatine suture is vital for making clinical decisions regarding the correction of transverse growth discrepancies of the maxilla. Several studies have used Cone Beam Computed Tomography (CBCT) to evaluate skeletal maturity by midpalatine suture staging (MPS) in various populations. A few patterns of staging did not fit the standard classification. Hence, the rationale of this research was to explore potential new subcategories of maturation staging using CBCT. The study aimed to develop a new comprehensive classification subcategorization system for midpalatine suture maturation staging based on CBCT scans. Methods: The study involved the retrospective analysis of 168 CBCT scans. The standard reference for MPS staging was taken from a previous published classification in 2013 using CBCT. Each classification stage of the standard classification was subcategorized into Pattern A and Pattern B. Results: Both classifications (standard reference and new) can rely on age to predict the possibility of maturation of the MPS compared to non-maturation. Age is a predictable variable of suture opening in both classifications. Conclusions: The new classification demonstrated increased sensitivity in detecting midpalatine suture maturity and also increased the likelihood of utilizing non-surgical maxillary expansion compared to the previous classification. Evaluating suture staging in individual cases using CBCT is recommended for personalized diagnosis and optimal treatment planning for maxillary expansion. This advancement allows clinicians to use the new classification as a reliable tool to confidently predict non-surgical expansion success for more mature patients, thereby broadening the scope of orthodontic treatment without compromising patient outcomes. Full article

Root cementum is a specialized connective tissue with a critical role in tooth function and periodontal health. This narrative review aims to consolidate current knowledge regarding the influence of cementum on the pathophysiology of periodontitis and root caries, its remodeling during orthodontic tooth movement, its significance in regenerative strategies and implantology, along with the effect of selected stimulants. A comprehensive literature search was conducted across PubMed, Embase, and Scopus databases for articles fulfilling the inclusion criteria. The analysis revealed that cementum’s unique biological characteristics are fundamental to the success of periodontal regeneration, with biomimetic approaches showing promise for enhancing osseointegration of dental implants. Furthermore, the tissue is highly susceptible to mechanical forces, leading to adverse effects such as root resorption during orthodontic treatment. Its composition also renders it vulnerable to demineralization from root caries and damage from external stimulants. In conclusion, a profound understanding of the intricate biology of root cementum is essential for developing safer and more effective treatment modalities. The findings strongly support the development of targeted, cementum-oriented interventions and preventive strategies, thereby improving long-term success in restorative, periodontal, and orthodontic treatment. Full article

Background: Clear aligner therapy (CAT) represents a biomimetic orthodontic approach that uses flexible thermoplastic materials to reproduce the physiological tooth movement and mechanical load distribution of natural tissues. While these materials promote oral hygiene and aesthetic comfort, their long-term biological impact on the caries process remains uncertain. This retrospective study aimed to evaluate changes in the number of decayed teeth (ΔD) before and after clear aligner treatment and to identify duration-dependent risk factors. Methods: This retrospective study included 362 patients (279 females, 83 males) treated with Invisalign^® aligners between 2020 and 2024. Baseline and post-treatment panoramic radiographs were analyzed to determine decayed tooth counts. Age, sex, and total aligner count were recorded. Non-parametric tests, multivariable regression, and ROC analysis were used to assess predictors of ΔD. Results: The mean number of decayed teeth increased slightly from 3.54 ± 2.76 to 3.83 ± 2.93 (p < 0.001). Longer treatment duration was independently associated with caries progression (β = +0.0088 per tray, p = 0.0037), and each 10-tray increment increased the odds of new decay by 55% (OR = 1.55, 95% CI: 1.26–1.90). ROC analysis identified ≥42 trays as a clinically relevant threshold (AUC = 0.67). Conclusions: Clear aligner therapy demonstrated a statistically significant yet clinically small increase in caries incidence, primarily related to treatment duration. As a biomimetic orthodontic approach that integrates mechanical and biological dynamics, extended clear aligner use may alter biofilm–surface interactions and salivary conditions over time. Therefore, preventive strategies–such as professional fluoride applications, strict cleaning protocols, and shorter recall intervals–should be emphasized for long-duration treatments to preserve the biological benefits of this biomimetic system. Full article

Introduction: Hemifacial hypoplasia is the second most common congenital craniofacial anomaly after cleft lip and palate. Mandibular ramus deficiency represents a key component of this condition, and vertical augmentation is traditionally managed with distraction osteogenesis. However, technical challenges related to device positioning and vector control continue to limit its reproducibility. This study aims to describe and compare three surgical techniques for mandibular ramus augmentation in hemifacial microsomia and to develop a surgical treatment algorithm based on individual anatomical characteristics and clinical complexity. Materials and Methods: From 2010 to 2022, eighteen patients with Pruzansky–Kaban grade I–IIb hypoplasia underwent staged orthodontic–surgical treatment at our institutions. The standard protocol included initial ramus vertical augmentation followed by bimaxillary osteotomy for asymmetry correction. The patients were equally divided into three groups of six patients each, based on the surgical technique employed. Three representative cases were selected to illustrate the evolution of our approach: (1) bidirectional distraction following a full-thickness osteotomy above the lingula; (2) unidirectional distraction applied to a sagittal ramus osteotomy according to Obwegeser; and (3) direct vertical augmentation with rigid fixation after sagittal osteotomy, supported by virtual surgical planning. Results: Vertical ramus augmentation of 15–25 mm was achieved in all cases. The first technique proved effective but technically demanding. The second approach improved vector control and device stability. The third, involving direct vertical augmentation with rigid fixation, simplified the procedure, reduced costs, and maintained bony contact for stable healing. Conclusions: Sagittal ramus osteotomy with direct stabilization represents a promising alternative to traditional distraction in selected patients, combining historical surgical principles with computer-assisted planning to achieve reproducible outcomes. Full article

Background/Objectives: This study aimed to evaluate the functional adaptation of the masseter muscle in growing individuals after one year of orthodontic treatment by assessing changes in its thickness. Methods: Twenty children with a mean age of 10.4 ± 2.1 years undergoing orthodontic treatment were monitored over one year. Ultrasonographic measurements of masseter muscle thickness were taken before the commencement of orthodontic treatment and one year later. Eighteen orthodontically untreated children with a mean age of 9.9 ± 2.0 years served as the control group; their masseter muscle thickness was measured at baseline and after the same follow-up period. Comparisons were made between the two groups. Results: At baseline, the mean masseter muscle thickness was 11.4 ± 1.3 mm in the control group and 11.7 ± 1.4 mm in the treatment group. After one year, children in the untreated control group showed an average increase of 0.5 ± 0.6 mm (p < 0.001) in the thickness of the masseter muscle, whereas those undergoing orthodontic treatment exhibited an average decrease of 0.6 ± 0.7 mm (p < 0.001). Multiple regression analysis accounting for age, gender, and initial masseter muscle thickness indicated that orthodontic treatment resulted in a reduction in masseter muscle thickness by 1.1 mm (p < 0.001) compared with the untreated control group. Conclusions: Orthodontic treatment may influence the development of the masticatory muscles. In our sample, the masseter muscle showed an estimated atrophy of approximately 9% after one year of orthodontic treatment compared with the thickness it would likely have achieved in the absence of any orthodontic intervention. Full article