Search Results (196)

Orthodontic treatment of high-angle skeletal Class II patients often leads to unsatisfactory facial profiles, highlighting the need to understand the relationship between dentoskeletal changes and soft tissue profile alterations. This retrospective study examined female Southern Chinese patients (n = 21, mean age 24.7 ± 4.8) with high-angle skeletal class II. Pre- and post-treatment lateral cephalograms were analysed for linear, angular, and proportional changes. Correlations between facial profile changes and dentoskeletal modifications were assessed using Pearson and Spearman’s coefficients. Results showed moderate correlations between changes in the facial angle with changes to the skeletal facial angle and skeletal Y-axis. A nearly perfect correlation was found between horizontal movements of the skeletal gnathion and changes in the nasolabial angle (r = 0.99, p < 0.001). Horizontal upper lip changes correlated with horizontal movements of upper (r = 0.70, p < 0.01) and lower incisors (r = 0.64, p < 0.01). No significant correlations were found between alterations to the incisors and changes in the facial angle or Y-axis. In conclusion, facial angle, Y-axis, and proportion changes relate closely to skeletal alterations but not to incisor positional changes, while lip changes correspond with incisor movements in high-angle skeletal Class II female patients. These findings are population-specific and require validation in male and other ethnic cohorts. Full article

Background: The anatomical position of the hyoid bone and the morphological characteristics of the soft palate play a key role in upper airway patency, craniofacial balance, and the coordination of functional structures. These features may vary depending on skeletal pattern and gender. This study aimed to evaluate the relationship between hyoid bone position, soft palate morphology, skeletal classification, and gender using lateral cephalograms. Methods: A total of 120 individuals (60 females and 60 males) were classified as Skeletal Class I, II, or III based on the ANB (A Point–Nasion–B Point) angle. Measurements reflecting hyoid position and pharyngeal airway width were analyzed, including C3–H (distance from the third cervical vertebra to the hyoid bone), C3–RGn (distance from the third cervical vertebra to retrognathion), H–RGn (distance from the hyoid bone to retrognathion), PNS–UPW (distance from the posterior nasal spine to the upper pharyngeal wall), and U–MPW (distance from the uvula to the middle pharyngeal wall). Soft palate types were classified according to the You classification. Statistical analyses included ANOVA (analysis of variance), the Kruskal–Wallis test, the independent samples t-test, the Mann–Whitney U test, and the chi-square test. Results: Significant differences in C3–RGn, H–RGn, and U–MPW were observed between Skeletal Classes I–III and Classes II–III (p < 0.05). In contrast, C3–H and PNS–UPW did not differ significantly among skeletal classes. Soft palate types showed no significant association with skeletal classification or gender. Gender-based comparisons revealed significant differences in C3–H, C3–RGn, H–RGn, and PNS–UPW (p < 0.05). Conclusions: Mandibular-related hyoid measurements and the U–MPW parameter were associated with skeletal pattern, whereas C3–H and PNS–UPW remained relatively stable. Soft palate morphology was not significantly influenced by skeletal class or gender. These findings suggest that the hyoid–tongue–soft palate complex should be evaluated in conjunction with mandibular position during orthodontic diagnosis and treatment planning. Full article

Background/Objectives: Virtual surgical planning (VSP) allows three-dimensional assessment of complex dentofacial deformities and has become integral to modern orthognathic surgery. However, evidence remains limited regarding how skeletal characteristics and malocclusion patterns translate into surgical movement selection. This study aimed to evaluate demographic features, skeletal malocclusion patterns, and clinical treatment strategies in patients undergoing VSP-guided orthognathic surgery. Methods: This retrospective study included 158 patients who underwent VSP-assisted orthognathic surgery between 2019 and 2025. Sagittal skeletal classification, vertical growth pattern, facial asymmetry, and maxillary crossbite were evaluated together with planned maxillary and mandibular movements. Surgical procedures were analyzed according to skeletal malocclusion classes (Class I, II, and III). Group comparisons were performed using chi-square and Kruskal–Wallis tests. Multivariable logistic regression analysis was conducted to assess factors associated with bimaxillary surgery (p < 0.05). Results: Skeletal Class I malocclusion was most prevalent (46.8%), followed by Class III (29.7%) and Class II (23.4%). Hyperdivergent growth patterns were predominantly observed in Class II patients, whereas normodivergent patterns were most common in Class III cases (p < 0.05). Mandibular advancement and setback generally followed expected class-based trends but were also observed across non-corresponding skeletal classes. Maxillary impaction and mandibular autorotation were frequently incorporated. Bimaxillary surgery was performed in 84.2% of cases. Logistic regression analysis showed no independent predictors of bimaxillary surgery (p > 0.05). Conclusions: VSP-assisted orthognathic surgery demonstrates that surgical planning cannot be reduced to sagittal skeletal classification alone. Treatment decisions are shaped by combined sagittal, vertical, transverse, and patient-specific factors, supporting a multidimensional and individualized planning approach. Full article

Congenital third molar (3M) agenesis is a common dental anomaly associated with genetic, epigenetic, and craniofacial growth factors. Evidence regarding its prevalence across populations and its relationship with sagittal and vertical growth patterns remains limited. This study aimed to compare the prevalence of 3M agenesis in Spanish and Peruvian samples and analyze its association with craniofacial growth patterns. A multicenter cross-sectional study was conducted in 1191 patients aged 10–14 years (348 Spanish, 843 Peruvian). 3M agenesis was assessed on digital panoramic radiographs. Sagittal and vertical growth patterns were evaluated using Steiner’s cephalometric analysis (ANB and GoGn–SN angles). Overall, 3M agenesis prevalence was 25.1%, with no difference between the Spanish (25.0%) and Peruvian (25.15%) groups. A non-significant trend toward higher prevalence was observed in Spanish females. 3M agenesis was more frequent in maxillary than mandibular 3M (16.8% vs. 10.2%; p < 0.001). Growth patterns differed between populations, with Class I and normodivergent patterns predominating in Spanish subjects, and Class II and hyperdivergent patterns in Peruvians (p < 0.001). No significant associations were found between 3M agenesis and sagittal or vertical growth patterns (p > 0.05), although Class II patients exhibited a higher prevalence of mandibular 3M agenesis (14.8% vs. 10.8%; p = 0.04). 3M agenesis showed similar prevalence in both populations and was not associated with craniofacial growth patterns, except for mandibular 3M agenesis in Class II patients, suggesting a multifactorial etiology driven by genetic and developmental factors rather than demographic or skeletal variables. It should be noted, however, that the cross-sectional nature of the study, the recruitment of patients from university dental clinics, and the absence of multivariate regression analysis limit both the generalizability and the causal interpretation of the findings. Full article

Background: Contemporary three-dimensional morphometric analysis emphasizes quantitative modeling of anatomical interactions. However, the interplay between sagittal and vertical dimensions in determining maxillary transverse morphology remains inadequately characterized. This study introduces the Sagittal Modulation Effect (SME) framework—a model characterizing how sagittal relationships modify the association between vertical pattern and maxillary arch morphology. Methods: A retrospective cross-sectional analysis was conducted on 165 skeletally mature adults (mean age: 25.4 ± 4.8 years), stratified into skeletal Class I, II, and III groups (n = 55 each). Lateral cephalometric analysis and 3D maxillary digital models were obtained. A validated automated algorithm performed arch morphometric analyses. The primary hypothesis was tested using multiple linear regression with interaction terms, validated via bootstrap analysis and cross-validation. Results: A significant SME was identified (p < 0.001). The inverse correlation between SN-MP and maxillary width intensified progressively: minimal in Class I (r = −0.047, p_adj = 0.891), moderate in Class II (r = −0.387, p_adj_ = 0.024), and strong in Class III (r = −0.645, p_adj_ < 0.001). Regression confirmed significant interaction effects (SN-MP × Class III: β = −0.45, p < 0.001; SN-MP × Class II: β = −0.31, p = 0.003). Exploratory analysis identified cohort-specific statistical descriptors associated with narrower arches: SN-MP > 34.2° in Class III (AUC = 0.84) and SN-MP > 36.5° in Class II (AUC = 0.78). These require external validation. Conclusions: This study provides evidence that sagittal classification modulates the vertical–transverse relationship. The SME framework offers class-specific coefficients and exploratory stratification tools for future research pending multi-center validation. Full article

Background/Objectives: This study aims to evaluate mandibular condylar asymmetry in individuals with different types of skeletal malocclusions using a three-dimensional imaging technique, and to determine the relationship between these anomalies and condylar asymmetry. Methods: The study included 100 individuals who visited the Department of Orthodontics Faculty of Dentistry between 2015 and 2020 and underwent Cone-Beam Computed Tomography (CBCT) imaging for various reasons. The evaluation of condylar asymmetry was performed using the Habets method, and measurements were carried out with the NemoCeph V.2017 software. Participants were categorized into skeletal Class I (2–4°), Class II (>4°), and Class III based on their ANB angles. For statistical analysis, frequency distribution, the Kruskal–Wallis H test, and Spearman’s correlation coefficient were used. Results: No statistically significant relationship was found between gender and skeletal classifications (p > 0.05). In terms of age, the mean age of individuals in the Class III group was significantly lower than that of those in the Class II group (p < 0.05). A weak positive correlation was observed between condylar and ramal indices in the overall sample (p = 0.029); however, this correlation was found to be moderate and statistically significant only within the Class III group (p = 0.002). Conclusions: The presence of a significant relationship between condylar and ramal asymmetries in individuals with Class III malocclusion indicates an increased risk of developing facial asymmetry if left untreated. These findings underscore the importance of skeletal malocclusions in influencing condylar morphology. Full article

Objective: This study aimed to evaluate the relationship between craniocervical posture and skeletal malocclusion patterns in adolescents. Methods: This cross-sectional study included 80 adolescents aged 10–15 years diagnosed with skeletal Class I, Class II Division 1, Class II Division 2, or Class III malocclusion. Postural parameters—Sagittal Head Angle (SHA), Craniocervical Angle (CA), and Shoulder Angle (SA)—were assessed using standardized sagittal-plane digital photographs obtained in Natural Head Position. Skeletal classification and cephalometric measurements (SNA°, SNB°, ANB°, GoGn/SN°, and Occlusal Plane/SN°) were determined from lateral cephalometric radiographs. Intergroup comparisons were performed using the Kruskal–Wallis test, and posture–skeletal relationships were evaluated using Pearson and Spearman correlation analyses (p < 0.05). Results: No significant differences were observed in postural parameters among skeletal malocclusion classes (p > 0.05). In the overall sample, SHA showed weak negative correlations with SNA° (r = −0.284, p < 0.01) and SNB° (r = −0.381, p < 0.01), and a weak positive correlation with Occlusal Plane/SN° (r = 0.235, p < 0.05). No significant associations were identified for CA or SA. Subgroup analysis demonstrated that these associations were present exclusively in the Class II Division 2 group, where SHA showed strong negative correlations with both SNA° (r = −0.653, p < 0.01) and SNB° (r = −0.605, p < 0.01). Conclusions: Sagittal head posture may show phenotype-specific associations during adolescence, particularly in Class II Division 2 malocclusion. Incorporating postural assessment into orthodontic evaluation may enhance diagnostic understanding during growth. Full article

Background/Objectives: Pediatric sleep-disordered breathing (SDB) is influenced by craniofacial morphology and host susceptibility. Evidence integrating cephalometric airway features with targeted genetic variation in symptomatic skeletal Class II children remains limited. We explored whether children with skeletal Class II mandibular retrognathia and SDB symptoms harbor selected genetic variants and whether carriers show distinct cephalometric airway characteristics. Methods: This cross-sectional study included 48 children with skeletal Class II malocclusion, mandibular retrognathia, and snoring/mouth-breathing symptoms. Craniofacial and airway parameters were assessed on lateral cephalograms. SDB burden was evaluated by a baseline home sleep study (respiratory event index, REI). Targeted sequencing screened TNFRSF1A, PSTPIP1, SLC6A4 (5HTT), ACE, APOE, IRS1, and additionally PHOX2B and PMP22. Exploratory group comparisons used Student’s t-test. Results: Variants were identified in 13/48 participants (27%) in TNFRSF1A, PSTPIP1, SLC6A4, ACE, APOE, and IRS1; none were detected in PHOX2B or PMP22. C3–H was higher in variant carriers (39.90 ± 6.40 vs. 36.48 ± 3.95 mm; p < 0.05). HH1 (perpendicular distance from the hyoid bone to the C3–RGN line) was higher but not significant (16.99 ± 7.58 vs. 14.61 ± 5.25 mm; p > 0.05). Conclusions: In this clinically screened pediatric skeletal Class II cohort with SDB symptoms, selected genetic variants co-occurred with specific hyoid–cervical cephalometric features. Given the cross-sectional design, absence of a control group, and small number of carriers, findings are exploratory and require replication in larger, controlled cohorts with standardized phenotyping. Full article

Facial profile esthetics play a pivotal role in orthodontic diagnoses, treatment planning, and patient satisfaction; however, the perception of facial attractiveness is inherently subjective and varies according to professional expertise and sociocultural background. This study aimed to compare the perceived attractiveness of standardized sagittal facial profiles across skeletal Class I, II, and III patterns and to investigate the influence of professional training and sociodemographic variables on facial profile evaluations. It was hypothesized that straight facial profiles would be perceived as the most attractive across all observer groups, while deviations from the orthognathic profile would be rated as less attractive, with significant differences based on professional training and sociodemographic variables. This cross-sectional descriptive study included 509 participants, comprising orthodontists, orthodontic Ph.D. students, general dentists, specialist dentists, first- and fifth-year dental students, and laypersons. Seven standardized sagittal facial profile silhouettes (S1–S7) were digitally generated from a standardized lateral facial photograph and evaluated using a seven-point visual analog scale. Participants were also asked to identify the sagittal facial profile range (S8) they ideally preferred to possess. Intergroup comparisons were performed using non-parametric statistical tests (Mann–Whitney U and Kruskal–Wallis). The straight profile (S3) emerged as the most attractive and most frequently preferred across all participant groups, confirming its role as the dominant esthetic reference. Retrusive profiles, particularly bimaxillary retrusion (S2), mandibular retrognathism (S5), and maxillary retrusion (S6), were consistently rated as the least attractive. Significant differences in esthetic perceptions were observed according to the professional expertise, educational level, age, and nationality, whereas gender had no clinically meaningful effect. Orthodontic training was associated with increasingly critical evaluations, especially for protrusive and convex profiles, while laypersons demonstrated greater esthetic tolerance. Both anatomical characteristics and sociocultural experience shape the perception of facial profile esthetics. While the straight profile represents a widely shared aesthetic ideal, increasing orthodontic expertise accentuates discrepancies between professional standards and public preferences. These findings underscore the necessity of integrating patient-centered and culturally sensitive considerations into contemporary orthodontic treatment planning. 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: The shift toward precision orthodontics necessitates population-specific cephalometric databases. Reliance on Eurocentric norms for ethnically diverse populations—particularly underrepresented Middle Eastern groups—represents a significant evidence gap. This study establishes initial normative cephalometric data for Yemeni and Northern Turkish Cypriot (NTC) adults. Methods: This retrospective comparative study analyzed 400 lateral cephalograms from skeletal Class I adults (200 Yemeni and 200 NTC; age 18–40; gender-balanced). Twenty standardized parameters were assessed using VistaDent OC™ software (version 4.2.61, GAC Orthodontic Software solutions, Birmingham, AL, USA). Analyses included *t*-tests, MANOVA, effect size computations (Cohen’s *d*), and variance partitioning. The False Discovery Rate method controlled multiple comparisons. Results: Yemeni adults exhibited a more vertical facial growth pattern (indicated by a lower Jarabak ratio: 60.18 ± 4.50% vs. 65.79 ± 5.20%; *d* = 1.15) and pronounced soft-tissue convexity (N-A-Pog: 5.76 ± 1.20 mm vs. 3.82 ± 1.10 mm; *d* =1.69). NTC adults showed a mild skeletal Class II tendency (ANB: 4.51 ± 1.70° vs. 3.35 ± 1.50°; *d* = 0.72). Ethnicity accounted for 21.3% of craniofacial variance (partial η² = 0.213). Conclusions: This study provides foundational cephalometric reference data for two underrepresented populations. The significant morphological distinctions quantified here underscore the necessity of developing population-specific norms. These data should be considered as one component within comprehensive, individualized diagnostic frameworks in orthodontics, rather than standalone diagnostic criteria. Full article

Background/Objectives: This retrospective study evaluated and compared the cephalometric effects of an elastodontic bioactivator and conventional high-pull headgear in growing patients with hyperdivergent Class II malocclusion. Methods: Patients aged 7–11 years were divided into two groups according to the appliance used for the orthodontic treatment performed: elastodontic device (ED) and high-pull headgear (HPHD). Cephalometric measurements were recorded at baseline (T0) and after 18 months of treatment (T1). The data were subjected to statistical analysis, descriptive statistics were calculated, and an ANOVA test and post hoc Tukey test were performed (repeated measures correction was applied for intragroup comparisons). Linear regressions were conducted. Significance was predetermined as p < 0.05 for all the tests performed. Results: 40 patients were included, 20 belonging to the ED group and 20 to the HPHD group. Both groups showed a significant increase in SNB (p < 0.05), suggesting favorable mandibular positional changes. SNA and ANB did not show significant intra- or intergroup variations (p > 0.05). Regarding vertical skeletal parameters, no significant intra- or intergroup changes were observed at T0 and T1, indicating that both devices preserved vertical stability without worsening the hyperdivergent pattern. Dentoalveolar and soft-tissue effects were limited. Conclusions: Both ED and HPHD are effective in managing hyperdivergent Class II growing patients. The two appliances provide comparable improvements in mandibular positioning. Both devices seem to preserve vertical skeletal dimensions, avoiding further mandibular clockwise rotation. Both appliances are associated with minimal undesirable effects on the soft tissues. Full article

Functional appliances constitute a common treatment approach for skeletal Class II malocclusion. However, evidence regarding the effects of appliance design and manufacturing workflows on treatment outcomes remains limited. This study aimed to compare the skeletal, dentoalveolar, and soft tissue effects of conventionally fabricated, prefabricated, and digitally designed functional appliances. A total of 28 growing patients with skeletal Class II malocclusion were retrospectively assessed and evenly assigned to four treatment groups: Twin Block, PowerScope, Invisalign Mandibular Advancement, and digitally designed Herbst. Skeletal, dentoalveolar, and soft tissue parameters were evaluated using lateral cephalometric radiographs obtained before (T0) and after treatment (T1). Statistical analyses included one-way ANOVA, repeated-measures ANOVA, and the Kruskal–Wallis test. All treatment modalities demonstrated significant sagittal improvement, characterized by reductions in ANB and Wits values and increases in SNB angle and mandibular length (Co–Gn). The Twin Block appliance showed a significantly greater increase in mandibular length compared with the other groups (p = 0.037). Dentoalveolar adaptations were more pronounced in the PowerScope and Invisalign Mandibular Advancement groups. In conclusion, within the limitations of this retrospective pilot study, functional appliances with different design and manufacturing characteristics appear to produce distinct skeletal and dentoalveolar response patterns, and digitally designed systems may represent clinically effective alternatives for the treatment of skeletal Class II malocclusion; however, these findings should be considered preliminary and interpreted with caution. Full article

The objective of the present study was to investigate whether orthodontic treatment alters the morphology and bone mineral density (BMD) distribution of the mandibular condyle in growing adolescent patients. Cone-beam computed tomography (CBCT) images were retrospectively analyzed for 29 patients (10 males and 19 females, aged 12.5 to 17.0 years) treated with full fixed orthodontic appliances. The right and left mandibular condyles were digitally isolated. For the internal control sample, the basal cortical bone (CB) at both mandibular first molar sites was also digitally dissected. A frequency plot of the CBCT gray values, proportional to BMD, was analyzed to calculate the mean and the 5th percentile of low and high gray values (Low₅ and High₅). Morphological changes in the condylar surface were assessed based on temporomandibular joint osteoarthritis (TMJOA) counts. Lateral cephalometric radiographs were used to measure facial morphology parameters and classify skeletal patterns. The cervical vertebral gray values of the same patients were compared. No radiographic signs of TMJ disorder were observed with no significant difference in TMJOA counts between before and after treatment (p = 0.56). The volume, mean and Low₅ gray values of the mandibular condyle, facial morphology parameters, and cervical vertebral gray values significantly increased following orthodontic treatment (p < 0.05). Skeletal Class II patients exhibited greater changes in mean, Low₅, and High₅ mandibular condyle gray values compared to their Class I patients (p < 0.05), whereas cervical vertebral gray values were not significantly influenced by skeletal classification (p > 0.19). The findings suggest that orthodontic treatment, combined with natural patient growth, contributes to nonpathological condylar alterations in adolescent patients. 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