Search Results (395)

Background and Objectives: There is a lack of comprehensive, focused reviews on the topic of open bite in the literature. This study aims to quantitatively reveal publication productivity, annual trends, publication sources, key themes, and citation patterns in the field of open bite. Materials and Methods: A total of 1208 articles and reviews published between 1973 and 2025, obtained from the Web of Science database, were analyzed using bibliometric and network analysis methods. Results: A significant increase in the number of publications after 2010, acceleration particularly after 2015, and high productivity observed in the 2018–2024 period. A clear increasing trend was observed over time. 71.5% of publications are included in SCI-Expanded. Journal distribution is centralized, with the American Journal of Orthodontics and Dentofacial Orthopedics and Angle Orthodontist being the dominant publications. Keyword and cluster analyses showed that the literature is concentrated on four main thematic axes: (1) etiology and biomechanical processes, (2) surgical approaches and orthognathic interventions, (3) early intervention and habit control, (4) post-treatment stability and relapse. Furthermore, treatment-oriented concepts such as “miniscrew/temporary anchorage device,” “molar intrusion,” and “cephalometric analysis” are central. Conclusions: The study reveals that open bite has become an increasingly prevalent and thematically diverse area of research in the orthodontic literature. The current distribution indicates that research focuses on both clinical application and treatment outcomes; however, it also highlights the importance of long-term comparative data and studies on treatment stability. In the future, methodological standardization and comparable long-term data will contribute to the maturation of the literature. Full article

Unlike skeletal Class I and II patients, the application of maxillomandibular advancement (MMA) in skeletal Class III patients with obstructive sleep apnea (OSA) is not well documented. The aim of this scoping review was to explore the variations and outcomes of MMA techniques in this unique subgroup. A comprehensive search of PubMed, Embase, Cochrane and LILACS databases were conducted for articles published up to May 2025. Nine studies met the inclusion criteria. Three main variations of MMA were identified: (1) Bimaxillary advancement, which provides the most significant airway enlargement across all pharyngeal regions but carries the highest risk of facial aesthetic distortion; (2) Maxillary advancement with mandibular auto-rotation, a less invasive option suited for patients with isolated maxillary retrusion and symmetrical mandibular anatomy; (3) Maxillary advancement with mandibular setback, which addresses aesthetic concerns in patients with mandibular excess but may compromise oropharyngeal airway space. All variations were reported to be effective in treating OSA (Reduction of AHI by at least 50%) but with different considerations. Surgical planning for skeletal Class III patients with OSA should be individualized based on craniofacial morphology, anatomical site of airway obstruction, and aesthetic considerations. A decision flowchart was shared in this study. Full article

Background/Objectives: Isolated cleft lips and/or palates often require orthognathic treatment. Traditional planning based on 2D images and plaster models limits precision; therefore, virtual surgical planning (VSP) and Computer-Aided Design and Computer-Aided Manufacturing (CAD/CAM) technologies are increasingly being used. The aim of this scoping review was to analyze the techniques, outcomes, and gaps in research on VSP in orthognathics for patients with isolated (non-syndromic) clefts. Methods: Searches were conducted in July 2025 in seven databases (including PubMed, Scopus, and Cochrane) without language restrictions, in accordance with the PRISMA guidelines for scoping reviews. Of the 2836 records, 36 publications were eligible after deduplication and full-text screening, and their Level of Evidence (LoE) was assessed using the Oxford CEBM scale. A risk of bias assessment was also conducted according to JBI tools. Results: The identified studies primarily comprised LoE III and IV; there were no systematic reviews or randomized controlled trials (LoE I). Descriptions of bimaxillary procedures and LeFort I osteotomies dominated. The most commonly used software was ProPlan CMF, Dolphin 3D, and Rhinoceros, although other tools have emerged in recent years. The available studies suggest that VSP increases translational and rotational accuracy and facilitates individualized treatment, and bimaxillary procedures bring better functional and aesthetic outcomes in patients with severe maxillary hypoplasia. Conclusions: Despite the growing interest in VSP in orthognathics, the scientific evidence is limited and mostly of lower quality. Well-designed prospective studies are needed to assess the long-term stability, quality of life, and cost-effectiveness of modern technologies. Full article

In addition to standardized lateral cephalometric radiographs, comprehensive assessment using dental cone-beam computed tomography (CBCT) and CT has become commonplace in the diagnosis and treatment of jaw deformities. Simulation based on cephalometric and CT data is particularly useful in the management of jaw deformities, both for evaluation and prognostic prediction. As such imaging examinations cover a wide anatomical region, it is not uncommon for various incidental pathologies to be discovered. This review emphasizes the necessity of evaluating the entire imaged area in addition to the chief complaint. Furthermore, it outlines the essential anatomical structures that should be assessed during diagnostic imaging performed prior to representative surgical procedures for jaw deformities (e.g., sagittal split ramus osteotomy and Le Fort I osteotomy). This review paper is descriptive in nature, incorporating our facility’s empirical aspects, and presents representative cases in a narrative format; it is not a systematic review. In other word, as the evidence-based literature does not cover all aspects of pretreatment evaluation, these criteria are based on the past experience of the authors. Full article

Purpose: Orthognathic surgery is a cornerstone therapeutic approach for correcting dentofacial deformities; however, its Impact on neuromuscular adaptation remains incompletely understood, particularly regarding different surgical strategies. The aim of this study was to evaluate and compare neuromuscular changes in patients undergoing monomaxillary or bimaxillary orthognathic surgery. Methods: Eighty adult patients treated with combined orthodontic–surgical therapy were included (37 monomaxillary; 43 bimaxillary). A control group of 20 healthy adult subjects with physiological occlusion and no history of orthodontic or orthognathic treatment was included. Surface electromyography (sEMG) of the masseter and anterior temporalis muscles and mandibular kinesiography were performed using standardized protocols at five treatment phases. Electromyographic symmetry indices (Percent Overlapping Coefficient—POC), muscle activity (µV), IMPACT values, and mandibular movement parameters were analyzed. Results: During the presurgical orthodontic phase, both groups showed comparable reductions in neuromuscular activity. Postoperatively, monomaxillary patients exhibited earlier stabilization of sEMG symmetry and a faster increase in IMPACT values, approaching physiological reference ranges at the final follow-up. In contrast, bimaxillary patients showed greater variability and slower functional recovery. Mandibular opening and lateral movements improved in all patients, with more stable kinesiographic patterns observed in the monomaxillary group. Conclusions: Within the limitations of this study, neuromuscular adaptation following orthodontic–surgical treatment appears to be associated with the surgical approach adopted, rather than representing a direct effect of surgical extent. These findings support the role of functional assessment as a complementary component in the management of orthognathic patients. Full article

Background/Objectives: Three-dimensional virtual surgical planning (VSP) is increasingly central to contemporary orthognathic surgery, enhancing diagnostic precision and enabling more reliable forecasts of postoperative outcomes. NemoFAB (Nemotec, Madrid, Spain) is a recently developed digital platform that integrates CBCT data, digital dental models, and facial photographs into a single workflow. Despite its growing clinical use, independent validation of its predictive accuracy remains limited. This study evaluated how closely NemoFAB virtual predictions corresponded to actual postoperative results using standardized cephalometric parameters. Methods: Forty adult patients with dento-maxillofacial deformities requiring combined orthodontic–surgical treatment were included. Eleven cephalometric variables—common to both WebCeph (2D) and NemoFAB (3D)—were measured preoperatively, virtually in NemoFAB, and postoperatively. AI-assisted landmark placement was manually verified by two orthodontists. Statistical analyses included repeated-measures ANOVA, paired t-tests, Bland–Altman plots, and intraclass correlation coefficients (ICC) to evaluate agreement and predictive accuracy. Results: Overjet, overbite, maxillary incisor inclination, maxillary incisor exposure, mandibular incisor projection to the True Vertical Line, and occlusal plane angulation all showed statistically significant changes after surgery (p < 0.05). Bland–Altman analysis demonstrated the narrowest limits of agreement in Nemo–Post comparisons, indicating strong predictive alignment. ICC values showed excellent agreement for incisor angulation (ICC = 0.921–0.984) and Pogonion projection (ICC = 0.943). Consistently poor pre-Nemo agreement reflected expected discrepancies between initial anatomy and planned surgical correction. Conclusions: When predicting skeletal and dentoalveolar changes brought about by orthognathic surgery, NemoFAB showed a high degree of agreement, especially for parameters that are directly impacted by jaw repositioning. Its strong concordance with postoperative outcomes supports its reliability for virtual planning, interdisciplinary coordination, and surgical execution. Advances in soft-tissue modeling and AI-driven automation may further enhance predictive accuracy. Full article

Introduction: The trigeminocardiac reflex (TCR) is a brainstem reflex in which trigeminal stimulation precipitates abrupt vagally mediated cardiovascular changes, ranging from bradycardia to asystole. While classically described during down-fracture or pterygomaxillary disjunction in Le Fort I osteotomy, rhinocardiac events from lateral nasal wall manipulation are less emphasized in orthognathic surgery. Case presentation: A 32-year-old man undergoing Le Fort I osteotomy developed ventricular asystole during lateral nasal osteotomy. The maneuver was stopped immediately; chest compressions and a single dose of epinephrine were administered, with return of spontaneous circulation within approximately one minute. Surgery was aborted and the patient was transferred to the surgical ICU. Clinical discussion: The temporal association with lateral nasal wall manipulation, in the setting of controlled hypotension and multimodal anesthesia, is most compatible with a peripheral (V2) TCR-type event, although drug-related and hemodynamic contributors cannot be excluded. A mini review of orthognathic TCR reports underscores recurring high-risk steps (down-fracture, pterygomaxillary disjunction, mandibular maneuvers) and highlights lateral nasal osteotomy as a potential additional trigger. Management principles remain the immediate cessation of the stimulus, optimization of oxygenation and ventilation, anticholinergics for bradycardia, and epinephrine/advanced cardiac life support for instability or arrest. Conclusion: Lateral nasal osteotomy may trigger a TCR-like event with severe bradyarrhythmia or asystole during Le Fort I osteotomy, particularly in hemodynamically vulnerable patients. Anticipation, swift recognition, and prompt, protocolized management are essential for favorable outcomes. Full article

Background: Three-dimensional facial anthropometry is increasingly used in orthodontics and orthognathic surgery. Conventional face scanning systems such as Vectra^® and 3dMD^® are well validated but remain costly and technically demanding. The MetiSmile^® 3D face scanner provides a more affordable and portable alternative, yet its accuracy and reproducibility have not been rigorously evaluated. Methods: Validation was performed on a standardized mannequin head in two phases. Phase 1 assessed mesh reproducibility under artificial lighting (AL), natural lighting (n-AL), and after mesh-refinement (AL-F). Landmark-based pre-registration with Iterative Closest Point refinement was applied; root-mean-square error (RMS) and distance maps were calculated. In phase 2, three observers (student, resident, consultant) performed 14 predefined linear measurements by direct anthropometry (DA) and digital anthropometry (DiA). Intra- and inter-observer reliability was evaluated using intraclass correlation coefficients. Results: Phase 1 yielded mean RMS values of 0.041 mm (AL), 0.043 mm (n-AL), and 0.030 mm (AL-F), with largest deviations near eyes, alar regions, and lip commissures. Phase 2 showed excellent ICCs (≥0.997) and mean absolute DA–DiA differences of 0.25–0.33 mm, with only few differences > 2 mm. Conclusion: The MetiSmile^® scanner generates highly reproducible meshes and clinically acceptable linear measurements on mannequin models. Further validation on live subjects is warranted before routine clinical application. Full article

Background/Objectives: The aim of this study is to evaluate pretreatment osseous changes in the temporomandibular joint (TMJ) in orthognathic surgery patients using cone-beam computed tomography (CBCT) and to determine the distribution of the findings according to sagittal skeletal malocclusion groups. Methods: CBCT images of 103 patients (206 condyles) were retrospectively analyzed. Patients were classified as Class I, II, and III based on ANB angles. Condylar morphology was assessed for flattening, sclerosis, erosion, osteophyte formation, and subchondral bone cysts. All evaluations were performed by a single investigator (κ = 0.87). Group differences were analyzed using the chi-square test with Bonferroni correction (p < 0.05). Results: The most frequent alteration was flattening (29.6%), followed by sclerosis (11.2%), erosion (10.7%), osteophyte formation (8.3%), and subchondral bone cysts (4.4%). No significant sex-related differences were found (p > 0.05). A significant difference was observed only in sclerosis (p = 0.049), which was more prevalent in Class I than Class III. Flattening predominated in all groups, while erosion and osteophytes were more common in Class II, and sclerosis was more frequent in Class I. Conclusions: This study demonstrated that condylar flattening was the most common morphological alteration in orthognathic patients across all skeletal malocclusion groups. The higher prevalence of sclerosis in Class I compared with Class III suggests that mandibular positioning may influence adaptive and degenerative remodeling processes of the TMJ. This study emphasizes the importance of CBCT evaluation for detecting osseous changes in TMJ before orthognathic surgery and demonstrates that pre-existing alterations may impact surgical stability and postoperative functional outcomes. Full article

Orthognathic surgery restores functional balance and facial esthetics in patients with dentofacial deformities. The use of adjunctive facial implants—made from materials such as porous polyethylene, titanium, or polyetheretherketone (PEEK)—has increased to enhance contour and projection, although standardized guidelines for their selection and integration remain scarce. Following PRISMA-ScR guidelines, a systematic search of PubMed, Scopus, Embase, and LILACS identified studies reporting facial implants placed concomitantly with orthognathic surgery. Eligible studies included case reports, case series, observational studies, clinical trials, and reviews involving human patients, without language or date restrictions. Seventeen studies published between 1998 and 2025 met the inclusion criteria, comprising retrospective and prospective designs, case series, and one technical note. Implants were used in the malar, infraorbital, paranasal, chin, mandibular body, and angle regions. Materials included PEEK, porous polyethylene, silicone, hydroxyapatite, polymethylmethacrylate, and titanium. PEEK was mainly used for patient-specific implants, while porous polyethylene was commonly used as stock implants. Follow-up time, outcome reporting, and study design varied widely, reflecting substantial methodological heterogeneity and predominantly observational evidence. As a result, outcomes were primarily reported qualitatively, limiting comparative assessment and long-term inference. Overall, the available literature suggests that alloplastic facial implants may serve as useful adjuncts to orthognathic surgery for contour enhancement, with outcomes influenced by implant design, surgical expertise, fixation, and soft tissue conditions. However, the current evidence base remains limited, underscoring the need for standardized outcome measures, comparative studies, and longer follow-up to better inform clinical decision-making and future research. Full article

Background/Objectives: The primary objective of this study was to evaluate the accuracy of maxillary repositioning using a two-plate patient-specific osteosynthesis system. The secondary objective was to determine whether accuracy is influenced by the number of maxillary segments. Methods: A retrospective single-centre cohort study was conducted on patients undergoing bimaxillary orthognathic surgery with a maxilla-first two-plate PSO system. Virtual Surgical Planning was performed based on the Cone-Beam Computed Tomography (CBCT) data of the patient, with patient-specific plates being designed and manufactured accordingly. Postoperative CBCT scans (7–10 days post-op) were registered to the preoperative plan, and deviations in translation and rotation between the plan and results were determined. Sub-group analyses were performed on one-, two- and three-segment maxillary osteotomy patient groups. Results: The inclusion criteria were met by 61 patients, of whom 47 were included for analysis (mean age 27.9 ± 9.4 years). Sub-millimetre median translational accuracies were found: anteroposterior 0.7 mm, transverse 0.4 mm, vertical 0.6 mm. The median rotational deviations were ≤1° for yaw and roll, and 1.6° for pitch. Accuracy was consistent across the one-, two-, and three-segment osteotomy groups. Conclusions: The two-plate PSO system is clinically accurate in bimaxillary surgery. There is no significant difference in accuracy between one-piece and segmental osteotomies of the maxilla when using the two-plate system. Full article

Background/Objectives: Le Fort I osteotomy is a widely performed surgical procedure for correcting maxillary deformities, but it carries the risk of rare complications, including nasolacrimal duct (NLD) injury. This study evaluated the anatomical relationship between the nasolacrimal canal (NLC) and the maxilla across different skeletal patterns via cone-beam computed tomography (CBCT) to define safer zones for fixation during orthognathic surgery. Methods: This retrospective study included 76 patients (152 canals) scheduled for orthognathic surgery. The participants were classified into retrognathic, orthognathic, and prognathic groups based on SNA values. Four linear distances were measured on sagittal CBCT sections: from the superior (SL), middle (ML), and inferior (IL) points of the NLD to the anterior maxillary border and from the canine apex to the inferior NLC point (IC). A total of 608 measurements were analyzed via ANOVA, the Kruskal–Wallis test, and post hoc tests, with significance set at p < 0.05. Results: The ML distance was significantly greater in the prognathic group than in the retrognathic and orthognathic groups (p < 0.001). The IL distance was significantly shorter in retrognathic individuals (p < 0.001). No significant differences were found in SL (p = 0.063) or IC (p = 0.141) among the groups. Conclusions: The proximity of the NLC to the maxilla varies according to the skeletal pattern. The retrognathic maxilla results in shorter IL distances, suggesting increased risk during fixation, whereas the prognathic maxilla results in greater ML distances. Preoperative CBCT-based individualized evaluation is recommended to optimize fixation and reduce NLD injury risk in Le Fort I osteotomy. Full article

Mandibular asymmetry often requires orthognathic surgery, and postsurgical relapse remains a concern. The masseter muscle may influence stability, but most studies have emphasized volumetric rather than qualitative changes. This prospective study evaluated 24 patients with mandibular asymmetry using ultrasonography preoperatively and at 1, 3, and 6 months after surgery. The parameters measured were thickness, stiffness ratio, echo intensity, and blood flow. The results showed significant postoperative adaptations. Masseter echo intensity increased markedly at 1 month (p < 0.001), peaked at 3 months (p = 0.042), and decreased toward baseline at 6 months (p < 0.001). Blood flow increased significantly from T1 to T2 (p < 0.001). Bite force dropped transiently at 1 month (p < 0.001) but recovered by 6 months (p < 0.001). At baseline, BMI correlated with echo intensity (r = 0.724, p < 0.001) and grip strength correlated with bite force (r = 0.705, p < 0.001). The stiffness ratio difference (contraction–rest) correlated with bite force (right: r = 0.629; left: r = 0.690). Relapse occurred in 25% of patients and correlated only with preoperative deviation and not ultrasound indices. Conclusions: Ultrasonography revealed meaningful qualitative muscle changes during recovery, though these were not strong predictors of relapse. Ultrasound remains a reliable, noninvasive tool for monitoring postoperative adaptation. Full article

Background: Orthognathic surgery aims to align the jaws with the facial skeleton and correct dental occlusion. This paper introduces the concept of planning the maxillomandibular complex (MMC) as a whole, utilizing a t-forming set of landmarks: the maxillary central incisor, the chin, and the occlusal plane. Methods: The background, hypothesis, and rationale of the new T concept are explained. A case of a 28-year-old male with skeletal class III malocclusion and an open bite was used to illustrate the application of the T concept in step-by-step surgical planning. The planning encompasses four phases: Phase One involves correcting frontal deformity and various asymmetries, Phase Two involves correcting chin anterior–posterior deformity, Phase Three involves correcting anterior–posterior and vertical MMC position, and Phase Four involves correcting MMC rotation. Results: The T concept provided a structured approach to plan MMC as a whole and integrate all structures into harmony. Conclusions: The T concept provides a logical approach to MMC positioning in orthognathic surgery, addressing functional and aesthetic concerns. It acts as a checkpoint to verify MMC position, helping surgeons achieve better results and avoid compensatory procedures. Full article

Background/Objectives: Combining orthognathic surgery with orthodontic therapy is a crucial approach for correcting severe dentofacial deformities that orthodontics alone cannot address. This study aimed to quantify skeletal, dental, and soft tissue alterations following orthognathic surgery and to assess correlations among cephalometric parameters to improve understanding of treatment outcomes. Methods: A prospective observational study was conducted on 25 Romanian patients (44% female and 56% male; median age, 28 years) who underwent orthognathic surgery. Standardized pre- and postoperative lateral cephalometric radiographs were analyzed using WebCeph 2.0.0 software. The evaluated parameters included the SNA angle (sella–nasion–point A, indicating maxillary position), SNB angle (sella–nasion–point B, indicating mandibular position), ANB angle (maxillo-mandibular relationship), Pog-N-Perp (distance from pogonion to the nasion-perpendicular line), U1–NA° (inclination of the upper incisor relative to the maxillary base), L1–NB° (inclination of the lower incisor relative to the mandibular base), nasolabial angle, and facial convexity. Statistical analyses included paired t-tests and correlation analysis. Results: Significant anterior repositioning of the maxilla was observed, with SNA increasing from 83.6° to 86.3° (p = 0.019). The SNB angle remained stable, while ANB increased toward normalized sagittal relationships (0.9° to 3.0°, p = 0.060). Soft tissue analysis revealed a slight increase in the nasolabial angle (102° to 105°) and improved facial convexity. Strong correlations were found between skeletal parameters (SNB and ANB, r = −0.852, p < 0.001) and between skeletal and dental variables (ANB and L1–NB°, r = 0.652, p < 0.001), confirming coordinated skeletal–soft tissue adaptation. Conclusions: Orthognathic surgery significantly enhances skeletal balance and facial harmony, particularly through maxillary advancement. The integration of virtual surgical planning and interdisciplinary collaboration improves accuracy, predictability, and patient-centered outcomes in surgical orthodontics. Full article