Search Results (125)

Background and Objectives: Maintenance of condylar position during bilateral sagittal split ramus osteotomy (BSSRO) is important for preserving temporomandibular joint biomechanics and skeletal stability. During surgery, loss of muscle tone under general anesthesia may alter the condyle–fossa relationship, making accurate repositioning of the proximal segment challenging. Although manual positioning remains the most commonly used intraoperative approach, evidence regarding its ability to preserve the preoperative condyle–fossa relationship remains limited. This study evaluated changes in the condyle–fossa relationship following BSSRO performed with manual proximal segment positioning. Materials and Methods: This single-center retrospective study included lateral cephalometric radiographs of 14 patients (8 females, 6 males; aged 19–29 years) with skeletal Class III malocclusion treated with combined orthodontic treatment and BSSRO. Radiographs were obtained preoperatively (T0), immediately postoperatively (T1), and at the final follow-up examination (T2). Condylar position was assessed using a Cartesian coordinate system, joint space measurements, and the Condyle Position Index (CPI). Statistical analyses were performed using the Friedman and Wilcoxon signed-rank tests (p < 0.05). Results: Significant differences were observed in CPI and anterior joint space measurements across the observation periods. Interval analysis demonstrated increased CPI values and decreased anterior joint space measurements between T1 and T2, whereas no significant immediate postoperative changes were observed. Intra-observer reliability was excellent, with intraclass correlation coefficients exceeding 0.90 for all variables. Conclusions: Manual positioning of the proximal segment during BSSRO may provide acceptable immediate postoperative condyle–fossa stability but may not completely maintain the preoperative condyle–fossa relationship over time. Although no significant immediate postoperative changes were observed, significant changes in the condyle–fossa relationship were identified at the final follow-up examination. These findings support the need for further prospective studies incorporating clinical temporomandibular joint assessment and three-dimensional imaging. Full article

Prefabricated myofunctional appliances (PMAs) are designed to improve airway function by advancing the mandible, enhancing tongue posture, and reducing airway resistance, thereby facilitating nasal breathing in children with sleep-disordered breathing (SDB). This retrospective study evaluated the effects of PMAs on airway dimensions in children with skeletal Class II division 1 malocclusion. Patients were selected from a departmental database (2017–2019). The treatment group included children with Class II division 1 malocclusion, an incisor overjet of ≥6 mm, cervical vertebral maturation (CVM) stage III or earlier, and documented myofunctional dysfunction (e.g., adenoid hypertrophy, allergic rhinitis, or mouth breathing), with complete pretreatment and one-year follow-up lateral cephalometric radiographs. Patients with prior orthodontic intervention or poor compliance were excluded. A matched observation group consisted of untreated patients undergoing growth monitoring. Airway dimensions of the nasopharynx, oropharynx, and hypopharynx were measured using cephalometric radiographs, along with McNamara Airway Analysis. The total nasal symptom score (TNSS) was used as a self-report measure. A total of 34 patients (mean age 9.4 years) were included in the PMA group and 29 patients (mean age 9.6 years) in the observation group. Compared with controls, the PMA group demonstrated significant increases in nasopharyngeal (p = 0.044) and oropharyngeal (p = 0.039) airway areas, while changes in the hypopharyngeal area were not significant (p = 0.121). McNamara Airway Analysis also showed a significant improvement in upper pharyngeal airway dimensions (p = 0.018). TNSS revealed significant changes following PMA therapy (p < 0.001). These findings indicate that PMA therapy is associated with enlargement of the nasopharyngeal and oropharyngeal airway in children with skeletal Class II division 1 malocclusion, suggesting functional airway adaptation beyond simple mandibular advancement. Full article

Idiopathic root resorption is diagnosed when external root resorption occurs in the absence of an identifiable etiological factor. Two main forms are described in the literature: apical and cervical. Owing to the rarity of this condition and the limited number of published reports, evidence-based recommendations for orthodontic management are currently lacking. The aim of this study was to provide a narrative overview of published case reports describing orthodontic procedures performed in patients with idiopathic root resorption and to supplement the available literature with a detailed clinical case. A case of a 7-year-7-month-old female patient presenting with generalized idiopathic root resorption and a concomitant skeletal Class III malocclusion is described. In this patient, skeletal anchorage was used to support maxillary protraction in an attempt to obtain an orthopedic effect. The literature review had a narrative character and was based on a structured search of the PubMed, Scopus, and Web of Science databases covering the period from January 2010 to December 2025. Only English-language case reports meeting strict eligibility criteria were considered. Of 47 records initially identified, two fulfilled the inclusion criteria; an additional two case reports were retrieved through manual searching. Conclusions: Given that the available evidence is limited to isolated case reports and a single clinical observation, the present findings do not allow for reliable conclusions regarding the safety, effectiveness, or general applicability of orthodontic treatment in patients with idiopathic root resorption. Clinical management should therefore be individualized, with careful documentation and close radiological follow-up. Further well-documented clinical reports are required to better characterize treatment-related risks in this patient group. Full article

Objectives: The present study aimed to evaluate the sexual dimorphism of skeletal and dental anomalies in Romanian orthodontic patients and to describe several important cephalometric measurements in patients with dental malocclusions. Materials and Methods: A total of 450 orthodontic records of patients older than 8 years were evaluated. On lateral cephalometric radiographs, the following cephalometric angles were digitally determined: SNA, SNB, ANB, FMA, IMPA, Max1-FH, SN-Go-Gn, N-A-Pog, Ar-Go-Me, and interincisal angle. The sagittal skeletal and dental malocclusions were diagnosed by two calibrated investigators. Results: The sample comprised 58% females, with a mean age of 20.07 (±8.63) years. The prevalence of dental malocclusions within the Romanian orthodontic sample taken into study was: 50.7% class I, 26.7% class II division 1, 13.3% class III, 4.7% class II, and class II division 2. The prevalence of skeletal anomalies within the Romanian orthodontic patient sample was: 43.3% class I, 28.7% class II due to retrognathic mandible, 17.3% class II due to prognathic maxilla, 8.7% class III due to prognathic mandible, and 2% class III due to retrognathic maxilla. Female patients presented more frequently with Class I or Class II division 2 malocclusion, whereas male patients more frequently exhibited Class III malocclusion. Female patients exhibited skeletal Class II more frequently due to retrognathic mandible, while skeletal Class III, due to prognathic mandible, was more common in male patients. Male patients were more frequently normodivergent, while female patients were more frequently hyperdivergent. Female patients exhibited retroclined upper incisors more frequently, whereas male patients exhibited proclined upper incisors more frequently. Most of the patients with class II division 1 malocclusion were females and exhibited the following cephalometric characteristics: a class II skeletal anomaly due to retrognathic mandible, normal SNA angle, decreased SNB angle, increased ANB angle, proclined upper incisors, proclined lower incisors, decreased interincisal angle, normal vertical growth pattern, closed mandibular angle, and convex facial profile. Most of the patients with class II division 2 malocclusion were females and exhibited the following cephalometric characteristics: a class II skeletal anomaly due to retrognathic mandible, normal SNA angle, decreased SNB angle, increased ANB angle, retroclined upper incisors, proclined lower incisors, increased interincisal angle, hypodivergent vertical growth pattern with a short face tendency, closed mandibular angle, and convex facial profile. Most of the patients with class III malocclusion were males and exhibited the following cephalometric characteristics: both class I and III skeletal anomaly due to prognathic mandible, normal SNA angle, increased SNB angle, decreased ANB angle, proclined upper incisors, normally inclined lower incisors, increased interincisal angle, hypodivergent, normal vertical growth pattern, and a short face tendency, normal mandibular angle, and balanced facial profile. Conclusions: The observed cephalometric differences between Class I, II and III malocclusions provide clinically relevant markers in vertical, sagittal, and dental dimensions that may provide descriptive reference data for similar orthodontic clinical samples. Full article

Background: Orthodontic camouflage in Class III patients is a widely used treatment approach. However, its application is subject to specific clinical indications. This narrative review aims to synthesize the current scientific evidence and provide an overview of the available methods, their advantages and limitations, in order to guide the appropriate management of Class III camouflage cases. Methods: A literature search was carried out using five main scientific databases without restrictions. Inclusion criteria were all types of articles published on various orthodontic camouflage techniques for Class III malocclusion in adult patients. The string searches included “camouflage” and “Class III malocclusion”. In addition, a manual search was performed to identify further relevant articles. The methodological quality was assessed using the Oxford Centre for Evidence-Based Medicine (OCEBM) classification. Results: This narrative review synthesizes 128 studies on orthodontic camouflage in adult Class III malocclusion. Among the 128 articles included, 110 (86%) were case reports or small case series, corresponding to level 4–5 evidence. The remaining studies were observational in design, most of them retrospective, corresponding to level 2–3 evidence. Extractive or non-extractive treatment can be used for non-surgical treatment of a Class III in adults. In recent years, aesthetic techniques, such as clear aligners or lingual fixed appliances, have been efficiently performed. Carriere Motion III is a fast and efficient method to mask a Class III occlusal relationship. Moreover, the use of temporary anchored devices (TADs) has proven to be an effective and minimally invasive method for managing mandibular distalization and a retraction of the lower incisors. Conclusions: Although most reports are case-based, recent advances such as TADs and clear aligners offer effective non-surgical alternatives for selected mild-to-moderate cases. Careful patient selection remains critical. The evidence was low-quality, and further prospective studies are needed. Full article

Background: Accurate transfer of the surgical plan is essential in bimaxillary orthognathic surgery, where small discrepancies between planned and postoperative skeletal positions may influence functional and aesthetic outcomes. This study compared the three-dimensional (3D) accuracy and time efficiency of conventional and fully digital planning workflows using CBCT-based evaluation. Methods: This retrospective comparative study included 100 adult patients with skeletal Class II or III malocclusion treated by Le Fort I osteotomy combined with bilateral sagittal split osteotomy (BSSO). Patients were allocated to conventional planning (n = 50) or fully digital planning using IPS CaseDesigner (n = 50). Planned and postoperative CBCT datasets were superimposed using voxel-based cranial base registration. Linear deviations at A-point and Pogonion, total RMS error, planning time, and operative time were analyzed. Results: Mean deviations were lower in the digital group at A-point (1.28 ± 0.28 mm vs. 1.63 ± 0.36 mm) and Pogonion (1.49 ± 0.42 mm vs. 1.95 ± 0.44 mm) (p < 0.001). Total RMS deviation was reduced in the digital workflow (1.39 ± 0.39 mm vs. 1.80 ± 0.54 mm; p < 0.001). Planning and operative times were significantly shorter in the digital group (p < 0.001). Moderate correlations were observed between time variables and 3D deviations. Conclusions: Fully digital planning showed improved 3D accuracy and significantly reduced planning and operative times compared with conventional methods, while maintaining clinically acceptable deviations. Full article

Background: This retrospective case series evaluated the descriptive clinical observations of the bio-activator AMCOP^® TC in the treatment of growing patients with Class III dento-skeletal malocclusion. In recent years, elastodontic appliances have been introduced as an evolution of conventional functional appliances. Elastodontic therapy could be an excellent therapeutic alternative in the early treatment of patients with Class III dento-skeletal malocclusion. Aim: This retrospective experimental study evaluated the descriptive clinical observations of the bio-activator AMCOP^® TC in the treatment of patients with Class III dento-skeletal malocclusion and described four clinical cases. Materials and methods: The study included 11 subjects (5 males and 6 females, aged between 3 and 12 years) treated with the AMCOP^® TC bio-activator for Class III dento-skeletal malocclusion. Patients used the AMCOP^® TC device for two hours in the afternoon and all night for 6–8 months and then only at night. For each patient, cephalometric analyses were performed on latero-lateral teleradiographs both at the beginning of treatment (T0) and at the end of treatment (T1). Analyses were performed using DeltaDent^® software. Conclusions: Cephalometric observations between T0 and T1 showed changes in sagittal relationship parameters, including ANB values; however, these findings should be interpreted cautiously. Elastodontic therapy with an AMCOP^® TC appliance improved the correction of a Class III dento-skeletal malocclusion and postural restoration of the first cervical vertebrae. Although further studies are needed, AMCOP^® TC bio-activators may be considered a possible interceptive treatment approach in selected growing patients; however, the present findings should be interpreted with caution. Findings should be considered preliminary and interpreted with caution. Full article

Advanced cases of unilateral condylar hyperplasia might need combined joint reconstruction and orthognathic surgery. This report illustrates the feasibility of integrating digital planning, patient-specific prosthesis design, and orthognathic correction within a single-stage surgical workflow. A 23-year-old female patient presented with skeletal Class III malocclusion, facial asymmetry, and mandibular midline deviation due to left condylar hyperplasia. After preoperative orthodontic alignment, virtual surgical planning was carried out using specialised software to simulate resection of the hyperplastic condyle, with concurrent total TMJ replacement, contralateral sagittal split ramus osteotomy, and Le Fort I osteotomy. Based on this plan, patient-specific prosthetic components, surgical guides, and fixation plates were designed and manufactured. Surgery was performed according to the digital plan using a combined intraoral and extraoral approach. At 3-month follow-up, clinical and radiological assessments showed stable prosthesis positioning, improved occlusal relationships, restoration of facial symmetry, and high patient-reported satisfaction. However, given the single-case design and short follow-up, these findings should be considered preliminary, and further studies are necessary to evaluate long-term functional outcomes and reproducibility. Full article

Background: Management of skeletal Class III malocclusion of maxillary origin in late adolescence remains challenging, as conventional tooth-borne orthopedic approaches show reduced effectiveness at advanced stages of skeletal maturation. Minimally invasive, bone-anchored alternatives supported by digital workflows may improve clinical feasibility and patient acceptance. Objective: To describe a digitally guided clinical protocol combining a hybrid maxillary expander and supragingival mandibular miniplates, and to explore skeletal and dentoalveolar outcomes in late adolescents. Methods: This retrospective pilot clinical study included ten late adolescents (mean age 16.0 ± 1.3 years; range 13.8–17.7) in advanced skeletal maturation stages (CS4–CS6) with skeletal Class III malocclusion of maxillary origin. Treatment consisted of a hybrid maxillary expander anchored to palatal miniscrews and custom supragingival mandibular miniplates, placed using a fully digital workflow. Maxillary protraction was performed using a modified Alt-RAMEC protocol followed by continuous intermaxillary elastic traction for 12 months. Pre- and post-treatment cephalometric analyses were conducted. Results: A significant increase in SNA was observed (mean +6.1°, p < 0.001), indicating forward maxillary displacement. The Wits appraisal improved by 3.3 mm (p = 0.007), and the SeMax increased by 2.9 mm (p = 0.0013). No significant changes were found in the SNB or mandibular plane angle. Dentoalveolar effects were limited. Conclusions: Within the limitations of this pilot clinical study, the proposed digitally guided protocol demonstrated clinically relevant maxillary advancement with minimal dentoalveolar side effects and preserved vertical control. This relatively minimally invasive approach compared to conventional subgingival miniplates and orthognathic surgery may represent a feasible treatment option for selected late adolescent patients. Further controlled studies are required to confirm these findings. Full article

Background/Objectives: This study aimed to evaluate the immediate effects of a 2-hinged expander activated with the alternate rapid maxillary expansion–constriction (Alt-RAMEC) protocol on craniofacial structures and the soft tissue periodontium in adolescents with skeletal Class III malocclusion characterized by maxillary retrusion. Methods: Lateral cephalograms obtained at baseline (T0) and immediately after treatment (T1) from 15 adolescents (6 females, 9 males; mean ages 12.6–13.1 years) treated with a 2-hinged expander using a 9-week Alt-RAMEC protocol were analyzed. A control group consisted of 27 untreated Class III individuals (7 females, 20 males; mean ages 12.5–12.6 years). Sagittal and vertical skeletal, dental, and soft tissue measurements were assessed using a Cartesian coordinate system. Periodontal parameters of supporting teeth were evaluated at T0 and T1. Statistical analysis was performed using the Mann–Whitney U and Wilcoxon tests (p < 0.05). Results: Significant anterior maxillary displacement was observed in the treatment group compared with controls (p < 0.01), accompanied by increases in overjet and Wits appraisal (p < 0.05), while mandibular position remained unchanged. The upper lip advanced in accordance with skeletal changes (p < 0.05). Gingival index, bleeding index, and probing pocket depth increased significantly in supporting teeth (p < 0.05), whereas plaque index remained stable (p > 0.05). Conclusions: The 2-hinged expander combined with a 9-week Alt-RAMEC protocol induces immediate skeletal maxillary advancement in growing Class III patients with minimal dental compensation. Short-term periodontal changes suggest a transient inflammatory response associated with appliance therapy. 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

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

Objective: This retrospective comparative cohort study investigated the craniofacial growth effects of the RAMPA (Right Angle Maxillary Protraction Appliance) system. The system aims to protract the maxilla in an anterosuperior direction to address maxillary hypoplasia and skeletal Class III malocclusion, potentially mitigating the posteroinferior displacement often associated with conventional orthopedic approaches. Materials and Methods: Craniofacial measurements were analyzed before (T1) and after (T2) RAMPA treatment in 30 growing patients (17 males, mean age 7.32 years; 13 females, mean age 8.34 years). Coben analysis was utilized to quantitatively evaluate coordinate relationships and proportional changes based on the Frankfurt Horizontal plane. Statistical significance was determined using paired t-tests or Wilcoxon signed-rank tests (two-sided, α = 0.05) without adjustment for multiple comparisons due to the exploratory nature of the study. Results: RAMPA treatment was associated with significant increases in facial depth (Ba-N) and anterior facial height (N-Me) in both sexes. Specifically, facial depth increased by an average of 2.65 mm in males (p = 0.001) and 2.18 mm in females (p = 0.007). Female patients showed a significant increase in the maxillary depth ratio (Ptm-A/Ba-N), while males exhibited a significant decrease in the Gonial Angle (avg. 1.47° decrease), suggesting anterior mandibular rotation. Conclusions: RAMPA treatment effectively promoted anterosuperior craniofacial growth and induced favorable mandibular rotation in this cohort. These findings suggest the system has potential clinical value for improving craniofacial balance in skeletal Class III malocclusion. While improved cervical posture is a theoretical benefit of such remodeling, systemic outcomes were not directly measured in this study. 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