Search Results (133)

Background: This study aimed to compare the measurement agreement and intramethod reliability of four cephalometric analysis workflows: manual tracing, semi-automated digital analysis (Dolphin), fully automated AI-based analysis (WebCeph), and expert-adjusted AI analysis (WebCeph+). Methods: In this retrospective method-comparison study, 67 lateral cephalometric radiographs were initially included. After the exclusion of radiographs containing extreme values, 54 radiographs (35 females, 19 males; mean age: 15.0 ± 2.13 years) were analyzed. Twenty-one skeletal, dental, and soft-tissue parameters (13 angular, 8 linear) were evaluated across the four methods. Intramethod repeatability was assessed via the intraclass correlation coefficient (ICC). Intermethod comparisons were analyzed using ANOVA and post hoc pairwise tests. Pragmatic clinical relevance thresholds were predefined as ±2 degrees for angular measurements and ±2 mm for linear measurements. Results: All methods demonstrated high intramethod reliability, with ICC values exceeding 0.90 in 20 out of 21 parameters. Manual and Dolphin methods yielded statistically comparable results (p > 0.05). In contrast, WebCeph differed significantly from manual and/or Dolphin in seven parameters, including SNA, IMPA, Go-Gn length, Pog to N-perpendicular, Wits appraisal, nasolabial angle, and mentolabial angle (p < 0.05). Several discrepancies exceeded the predefined pragmatic thresholds (±2 degrees and ±2 mm), highlighting their potential clinical relevance. After expert adjustment (WebCeph+), statistically significant inter-workflow differences were no longer observed; however, residual individual-level variability remained for selected parameters. Conclusions: Fully automated WebCeph analysis showed limited agreement with manual and semi-automated methods for several clinically relevant measurements. Expert adjustment reduced systematic mean discrepancies and improved agreement with clinician-dependent workflows; however, residual individual-level variability remained for selected parameters. AI-driven cephalometric analysis should therefore be considered a supportive tool requiring specialist verification rather than an unsupervised replacement for conventional methods. Full article

Background: Staphylococcus aureus neonatal osteomyelitis (SA-NOm) is a rare condition with the potential for lifelong skeletal morbidity. Available evidence remains scarce and inconsistent, with notable differences in clinical presentation, therapeutic regimens, and reported outcomes, underscoring the need for a systematic evaluation combining clinical experience with existing literature. Methods: We retrospectively reviewed data from all neonates admitted to Regina Margherita Children’s Hospital, Turin, Italy, between 2017 and 2024 with a diagnosis of SA-NOm. A structured narrative review of the pertinent literature published over the past 25 years was conducted to identify additional cases and compare management approaches. Results: Four neonates with SA-NOm were identified at our center (institutional cohort) while a literature review retrieved 38 additional cases (literature cohort) to establish a combined cohort (n = 42). Of these, 78% were born at term, with a male-to-female ratio of 1.6:1 (26 males, 16 females). Approximately half of the combined cohort presented identifiable risk factors for SA-NOm, including neonatal intensive care unit admission, prematurity, sepsis, or maternal complications. Across the combined cohort, the mean age at presentation was 19 days. The most common presenting signs were local swelling and reduced mobility of the affected limb, although systemic symptoms often complicated early recognition. Long bones were most frequently involved—particularly the femur, humerus, and tibia—with equal distribution between upper and lower extremities. The mean intravenous antibiotic duration for the combined cohort was 31.6 days, followed by two to three weeks of oral therapy. Empiric regimens varied, including glycopeptides alone or combined with second- or third-generation cephalosporins, anti-staphylococcal penicillins, or carbapenems. Sequelae rates were rarely reported in the literature, likely due to limited follow-up, whereas extended surveillance in our cohort revealed substantial long-term morbidity, including restricted joint mobility, limb length discrepancy, and persistent radiographic abnormalities. Conclusions: SA-NOm, due to its rarity and potential for long-term skeletal sequelae, requires early diagnosis and timely empiric antibiotic therapy based on local resistance data. Prospective multicenter studies are needed to define standardized diagnostic and therapeutic protocols. Full article

Interceptive orthodontics plays a key role in the early management of dento-skeletal discrepancies in growing patients, particularly transverse maxillary deficiency. This retrospective clinical study evaluated the dento-skeletal effects of a digitally manufactured, patient-specific Transversal Sagittal Maxillary Expander (TSME). A sample of 45 pediatric patients (mean age 8.5 years) with transverse and sagittal maxillary deficiency was analyzed. All subjects were treated using a customized titanium TSME designed through a multimodal digital workflow combining intraoral scanning, CBCT imaging, and three-dimensional facial acquisition for diagnostic planning and appliance customization. Quantitative treatment outcome assessment was based on standardized lateral cephalometric analysis between pre-treatment (T0) and post-treatment (T1). Statistically significant changes were observed in sagittal and vertical skeletal parameters, including SNA, SNB, ANB, SN–ANS-PNS, SN–GoGn, N–Me, and APDI. The integration of digital technologies and titanium additive manufacturing may support improved appliance customization and workflow standardization. Within the limitations of this retrospective study, digitally manufactured TSME represents a promising approach for patient-specific appliance customization in interceptive orthodontics. Full article

Interleukin-6 (IL-6) is a cytokine with multiple biological effects. It plays a complex and seemingly paradoxical central role in both the physiological homeostasis and pathological processes of skeletal muscle. Under physiological conditions, particularly during acute exercise, IL-6 produced and secreted by the contracting skeletal muscle itself acts as an important “myokine.” It operates in an autocrine, paracrine, or endocrine manner to regulate systemic energy metabolism, insulin sensitivity, muscle regeneration, and adaptive hypertrophy. This function is crucial for the health benefits conferred by exercise. However, under various pathological conditions—such as cancer cachexia, sepsis, muscular dystrophy, denervation, disuse atrophy, and chronic inflammatory diseases—persistently elevated systemic or local IL-6 levels become a key mediator driving skeletal muscle atrophy, metabolic disorders, and functional decline. This review systematically elaborates on the dual role of IL-6 in skeletal muscle. It provides an in-depth analysis of its downstream signaling pathways (e.g., JAK/STAT, gp130, MAPK, PI3K-Akt) and upstream regulatory mechanisms (e.g., the Piezo1/KLF15 axis, calcium signaling, mitochondrial function, oxidative stress). A particular focus is placed on discussing the distinct biological effects of classical IL-6 signaling versus trans-signaling. Furthermore, we address current challenges in research and practice, including the cell specificity of IL-6 signaling, the complexity of its temporal regulation, the definition of physiological versus pathological concentrations, discrepancies between animal models and human diseases, and the plasticity of its function across different pathological contexts. Finally, this review explores the potential of targeting the IL-6 signaling pathway as a therapeutic strategy for skeletal muscle atrophy and related metabolic diseases. Potential interventions include IL-6/IL-6R monoclonal antibodies, JAK/STAT inhibitors, gp130 modulators, exercise interventions, and nutritional strategies. This aims to provide a theoretical foundation and novel perspectives for future translational research and clinical interventions. Full article

Background/Objectives: Artificial intelligence has accelerated cephalometric analysis by enabling rapid and standardized measurements. However, whether these automated outputs can be considered clinically interchangeable with expert manual tracing remains unresolved, particularly for routinely used analyses such as Steiner. Methods: A comparative experimental study was conducted on 100 lateral cephalometric radiographs analysed using two parallel approaches: expert manual tracing and fully automated analysis with the WebCeph platform. Seven Steiner variables (SNA, SNB, ANB, 1–NA, 1–NB, interincisal angle, and FMA) were evaluated. Paired t-tests were used to assess differences between methods, while agreement was evaluated using intraclass correlation coefficients and Bland–Altman analysis. Particularly low agreement was observed for clinically relevant parameters such as ANB and FMA. Results: Six of the seven variables showed statistically significant differences between methods. Automated measurements systematically tended to overestimate both skeletal and dental parameters. Agreement was inconsistent and frequently poor, with ICC values ranging from 0.01 to 0.60 for clinically relevant variables such as ANB and FMA. Importantly, small or non-significant mean differences did not translate into acceptable agreement. Bland–Altman analysis confirmed the presence of systematic bias and wide limits of agreement, especially for dental measurements. Conclusions: Despite its speed and automation, WebCeph does not achieve clinically acceptable agreement with expert manual tracing across several key cephalometric variables. The observed discrepancies—particularly in parameters critical for sagittal and vertical diagnosis—may compromise clinical interpretation and treatment planning. These findings support the use of AI-based cephalometric analysis as an adjunctive tool rather than a substitute for clinician-guided evaluation. Full article

Background/Objectives: Distal femoral physeal fractures are rare and particularly uncommon in very young patients, as they typically require a significant amount of kinetic energy. They carry a high risk of premature physeal closure and later growth disturbance. We aimed to describe the management and long-term outcome of an open distal femoral physeal fracture in a 6-year-old child. Methods: We report a previously healthy 6-year-old child sustained an open distal femoral physeal fracture in an electric scooter–motor vehicle collision. Emergency treatment included trauma assessment, resuscitation, intravenous cefazolin, urgent irrigation and debridement, open reduction, crossed smooth Kirschner-wire fixation, and immobilization. Long-term follow-up included growth prediction using the multiplier method. Results: The injury was classified intraoperatively as a Salter–Harris type I distal femoral physeal fracture. Despite timely surgical treatment, progressive limb-length discrepancy developed, increasing from 1.3 cm at 10 months to 6.5 cm over 5 years. Growth prediction estimated a final discrepancy of 7.32 cm at skeletal maturity, and contralateral distal femoral epiphysiodesis was performed. The literature confirms that displaced high-energy distal femoral physeal injuries in younger children carry a substantial risk of premature physeal closure and later corrective surgery. Conclusions: Open high-energy distal femoral physeal fractures in young children are limb-growth-threatening injuries. This case demonstrates that satisfactory initial fracture management does not eliminate the risk of later premature physeal closure, and that clinically important discrepancy evolves gradually over several years. Long-term follow-up and growth prediction are essential to guide timely corrective treatment to minimize the leg-length discrepancy in bone maturity. Full article

Background: The majority of Class II malocclusions stem from mandibular deficiency, leading to chin retrusion. In growing patients, the ideal correction—aiming for a skeletal mandibular response—should avoid common pitfalls such as “Point B” dropping postero-inferiorly, excessive labial proclination of mandibular incisors, or the lingual tipping and extrusion of maxillary incisors. When planning mandibular advancement (MA) using clear aligners with integrated advancement features, biomechanical forces are not the only consideration; precise management of the lower incisor position is critical for success. Current literature highlights not a good control in digital planning software: these platforms are primarily dentoalveolar-based and lack integrated cephalometric analysis. Consequently, mandibular advancement is often defined by standard linear parameters (typically 2 mm per step), while incisor position is managed through virtual alignment without correlation to cephalometric landmarks like the Pogonion, NB line, or IMPA. The software cannot monitor real-time sagittal or vertical skeletal relationships, the software will elaborate the treatment planning after doctor’s prescription, the clinician must manually adjust incisor positioning based on external cephalometric analysis to prevent dental compensation or excessive proclination. Aim: This clinical case demonstrates a specific arch preparation protocol designed to optimize mandibular advancement in a growing patient with mandibular retrusion. Methods: A 12-year-old female presented with a skeletal and dental Class II malocclusion, characterized by increased overjet and a normal overbite. Treatment was conducted using Invisalign^® clear aligners (22 h/day wear, weekly changes). The treatment objectives were: transverse: Correct upper dentoalveolar contraction and coordinate arch form while restoring midline alignment; sagittal: establish Class I molar and canine relationships by correcting the overjet and reducing the labial inclination of the lower incisors; vertical: level the curve of Spee. A key clinical condition of our protocol was the pre-advancement phase: the lower arch was reshaped by reducing the buccolingual inclination (retroclination) and intruding the lower incisors. This was specifically intended to increase the available overjet space, creating the necessary room for subsequent mandibular advancement. Results Treatment was completed in 24 months with high patient compliance. Objectives were successfully met, including the correction of skeletal and dental discrepancies, the establishment of harmonious arch forms, and precise overjet reduction through enhanced control of the mandibular incisors. Conclusions: This case report outlines an optimized clinical strategy for Class II correction. Cephalometric Integration: Perform an initial analysis outside the digital planning software to define the ideal IMPA and NB angles. Anatomic Verification: Utilize radiographic overlays to ensure tooth movement remains within alveolar bone limits. Pre-MA Optimization: Prioritize a “pre-advancement” phase to maximize the sagittal inter-arch space (overjet). A larger overjet allows for a more significant orthopedic effect from the MA features. Stepwise Advancement: Implement mandibular advancement in increments (≥2 mm) with periodic clinical reassessment to facilitate the adaptation of the muscular sling and functional occlusion. Full article

Background: Skeletal deep bite malocclusion (Angle Class II division 2) represents a common vertical skeletal discrepancy characterized by excessive anterior overbite and a hypodivergent craniofacial growth pattern. The contribution of cranial base morphology to mandibular growth direction during early development remains incompletely understood. Objective: To evaluate the relationship between cranial base morphology and maxillofacial growth patterns in children with skeletal deep bite, using a longitudinal cephalometric approach. Materials and Methods: This retrospective longitudinal cohort study included 96 prepubertal patients aged 7–10 years (54 with skeletal deep bite, 42 Angle Class I dentoalveolar controls). Skeletal deep bite was defined by overbite > 4 mm and mandibular plane angle (FMA) < 22°. A total of 298 standardized lateral cephalometric radiographs (2–4 per subject; mean follow-up 24 ± 4 months) were analyzed. Twenty-two cephalometric parameters were assessed. Longitudinal changes were evaluated using repeated-measures analysis, and predictors of deep bite severity were identified using multiple linear regression. Results: Compared with controls, the deep bite group exhibited significantly reduced mandibular plane angle (18.5° vs. 24.0°), smaller gonial angle (104.3° vs. 111.0°), and decreased lower anterior facial height (86.3 mm vs. 92.0 mm; all p < 0.001). Differences in cranial base morphology were modest, including reduced anterior cranial base length (58.6 mm vs. 60.0 mm; p = 0.031). Regression analysis identified gonial angle and lower anterior facial height as significant predictors (R² = 0.58). Longitudinal analysis suggested early tendencies toward forward mandibular rotation and reduced vertical growth rate over the observation period. Conclusions: In prepubertal children, skeletal deep bite is associated with early tendencies toward reduced vertical facial development and forward mandibular rotation. Cranial base morphology appears to be associated with mandibular growth direction as a secondary modulatory factor rather than a primary determinant. Early identification of hypodivergent growth indicators may facilitate timely interceptive orthodontic strategies. 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

Objective: To determine the publication bias of the reported prevalence of malocclusions in Mexican children and adolescents. Background: Publication bias determination is crucial in a systematic review, helping to ensure the conclusions’ validity and reliability. Nevertheless, without accurate knowledge of disease prevalence and patterns, the health system risks inefficiency, inequity, and failure to meet the population’s needs. On the other hand, malocclusions can impair proper chewing efficiency, contributing to digestive alterations, and nutritional deficiencies among other functional, psychological, and social problems. The data of the prevalence of malocclusion is imperative to implement early interventions in health services that prevent more severe skeletal discrepancies and reduce the need for invasive treatments in adolescence or adulthood. Methods: Studies were collected from five databases, following the PRISMA and Cochrane guidelines for systematic reviews. Eligibility criteria were full-text research in which the prevalence of malocclusions was reported. The risk of bias (Hoy tool), publication bias (the Doi plot and the Luis Furuya-Kanamori (LFK) index), and quality assessments (GRADE tool) were performed. The data were combined using a random-effects meta-analysis. Results: The result of the meta-analysis suggests a high prevalence of malocclusions in mixed dentition was 50.2% (95% confidence interval [CI]: 38.9–61.5%). However, the studies showed a risk of bias and publication bias. Conclusions: In Mexico, there is a high prevalence of malocclusions among children and adolescents. However, these results are not robust enough to draw solid conclusions, due to the low certainty of the evidence. Full article

Background/Objectives: The growth status of children and adolescents with discrepancies of maxilla/mandible during the growing period should be closely monitored to determine the appropriate time to begin growth modification in orthodontic treatment. Skeletal growth assessment using the cervical vertebral maturation (CVM) method is widely used and accepted; however, monitoring requires additional doses of radiation. Thus, this study aimed to evaluate tooth development from routine panoramic radiographs to represent the growth status rather than using the CVM method. Methods: Three hundred and sixty pairs of lateral cephalometric and panoramic radiographs (180 males and 180 females) aged 7–15 years were included. Teeth 31–37 of each panoramic radiograph were identified as A to H according to the Demirjian method, and the stages of skeletal growth were indicated from lateral cephalometric radiographs using the CVM method. The relationship between tooth development and CVM was analyzed using Spearman’s rank correlation coefficients. Results: The correlation coefficients ranged from 0.487 to 0.768 for male subjects and from 0.503 to 0.759 for female subjects. Tooth 33 was found to have the highest correlation in males (r = 0.768) and tooth 37 was revealed to have the highest correlation in females (r = 0.759) (p < 0.01). Conclusions: Teeth 33–37 showed correlation coefficients close to 0.7 or above, which indicated a moderate-to-high correlation between tooth development and CVM. Thus, the pattern of tooth development from teeth 33–37 may serve as a supplementary indicator of skeletal maturation timing which was similar in both males and females, and may serve as a supplementary indicator of skeletal maturation timing. Full article

Background/Objectives: To Develop a CBCT-based transverse diagnostic method that establishes normative buccolingual inclination values for permanent first molars and objectively distinguishes between dentoalveolar transverse deficiency and skeletal maxillary deficiency. Methods: A total of 1120 initial CBCT scans were reviewed, and 40 subjects with normal occlusion met the inclusion criteria. Volumes were reoriented using a standardized three-plane protocol, and molar angulations were measured relative to reference planes parallel to the occlusal plane. Intra- and inter-examiner reliability were assessed using ICC. Descriptive, comparative, and correlation analyses were performed bilaterally and between arches. Results: No significant right–left differences were observed for upper molar angulation (URM vs. ULM: 99.5° vs. 99.1°; t(19) = 1.560, p = 0.135) or lower molar angulation (LRM vs. LLM: 78.9° vs. 78.9°; t(19) = 0.301, p = 0.767). Non-parametric analysis confirmed these findings (ULM vs. URM: Z = −1.203, p = 0.229; LLM vs. LRM: Z = −0.427, p = 0.669). Significant positive bilateral correlations were observed in both arches (upper: r_S = 0.784, p < 0.001; lower: r_S = 0.837, p < 0.001). A significant negative correlation was found between upper and lower molar angulations (left side: r_S = −0.626, p = 0.003; right side: r_S = −0.858, p < 0.001), demonstrating dentoalveolar compensation. Conclusions: CBCT enables the precise assessment of molar buccolingual inclination and the establishment of normative patterns essential for transverse diagnosis. The proposed method allows the quantification of the maxillary “basal defect” after virtual dental decompensation, providing an objective tool to differentiate dentoalveolar from skeletal transverse discrepancies and guide targeted treatment planning. Full article

Background/Objectives: Tai Chi (TC) practice has been shown to positively affect the physical, psychological, and cognitive health of older adults. However, discrepancies persist regarding its effectiveness compared to strength training (ST). This study aimed to determine the effect of TC training compared to ST on body composition, physical performance, cognitive function, and psychological well-being in older adults. Methods: A quasi-experimental study was conducted with a convenience sample of 68 women 60 years or older, divided into three groups: (i) Tai Chi Group (TCG) n = 26; (ii) Strength Training Group (STG) n = 21; and (iii) Control Group (CG) n = 21. TCG and STG performed physical training four days a week, 60 min/day, for six months. All participants were assessed for body composition (BFP, body fat percentage; SMM, skeletal muscle mass; SMMI, skeletal muscle mass index); physical performance (4MWT, 4 m walk test; STST, sit-to-stand test; OPP, overall physical performance; HGS, handgrip strength) and Wellbeing (PWBS, psychological well-being scale of Ryff, validated for the Mexican population). The data were analyzed per protocol using repeated-measures ANOVA (TCG & STG vs. CG; TCG vs. STG), and the mean difference (MD) was calculated. Results: TCG showed statistically significant changes in body composition, BFP (MD, −3.4 ± 8.2, p < 0.05), SMM (MD, 1.6 ± 1.4, p < 0.001), and SMMI (MD, 0.72 ± 0.61, p < 0.001) after the intervention compared to CG. However, no differences were observed between TCG and STG (p > 0.05). Regarding physical performance, TCG showed significant changes in 4MWT (MD, −1.0 ± 1.8, p < 0.01) and STST (MD, −3.7 ± 4.8, p < 0.05) compared to CG. Differences were also observed in STST between TCG and STG (MD, −3.7 ± 4.8 vs. 0.45 ± 3, p < 0.05). In addition, TCG showed a significant increase in HGS (MD, 1.1 ± 1.9, p < 0.05) compared to CG, although no differences were observed with STG (p > 0.05). Conclusions: Our findings suggest that TC is more effective than strength training for improving body composition, physical performance, and handgrip strength in older adults living in the community. Full article

Background/Objectives: Although discrepancies between bioelectrical impedance analysis (BIA) devices are well documented, their clinical relevance in vulnerable populations remains unclear. This study aims to assess the impact of device choice on muscle mass classification criteria in patients with cancer or obesity and to identify modifiers of device variability. Methods: BIA data from 224 adults (85 with cancer, 139 with obesity) measured with two segmental multi-frequency devices (seca mBCA 515 and InBody 970) were analyzed. Device differences were assessed using the Wilcoxon signed-rank test and agreement analyses. Differences in classification of body composition cut-offs cited in the GLIM criteria for malnutrition and the ESPEN and EASO criteria for sarcopenic obesity were evaluated using McNemar’s test. The impact of disease type, sex, and age on device differences was examined through multivariable models. Results: Significant device differences were found for all parameters (all p ≤ 0.005). Discrepancies were largest for skeletal muscle mass (kg and %), with effect sizes r > 0.8 and poor agreement (Lin’s CCC < 0.90). A significant impact of device choice on muscle mass classification was observed for both cancer and obesity patients (p < 0.001), with seca classifying more patients as having low fat-free mass (50% vs. 20%) and as having a body composition consistent with sarcopenic obesity (90% vs. 50%) than InBody. Discrepancies were more pronounced in cancer patients and females. Conclusions: Muscle mass assessment by BIA is highly dependent on device choice, potentially leading to clinically relevant discrepancies in classification when rigid cut-offs are applied. An individualized interpretation of BIA data and further validation of prediction equations in disease-specific subpopulations is warranted. Full article

Background and Objectives: Mid-term skeletal stability after bimaxillary orthognathic surgery in patients with facial asymmetry and a relatively normal sagittal skeletal relationship (ANB ≈ 1–4°) remains underreported. This study aimed to determine the three-dimensional characteristics and temporal changes in postoperative skeletal remodeling and symmetry maintenance in such patients. Materials and Methods: This retrospective case series included 25 patients (ANB ≈ 1–4°) undergoing bimaxillary orthognathic surgery. Three-dimensional computed tomography was performed preoperatively (T0), immediately postoperatively (T1), and at 6–12 months postoperatively (T2) to quantify bilateral condylar, ramus, mandibular body, maxillary parameters, and occlusal cant. Statistical analyses were performed using appropriate statistical methods for paired and repeated-measures designs. Results: Preoperatively, the long side exhibited significantly greater condylar volume, ramus height, and mandibular body length than the short side (all p < 0.05). Postoperatively, a “long-side reduction and short-side augmentation” strategy significantly reduced or reversed most bilateral differences, with a marked improvement in occlusal plane cant (p < 0.01). At T2, only mild bone remodeling was observed, with no significant loss of postoperative skeletal symmetry. The occlusal plane remained stable. Conclusions: In patients without marked sagittal discrepancies, bimaxillary orthognathic surgery effectively restores transverse and vertical skeletal symmetry. Mid-term stability is well maintained over 6–12 months, with only mild condylar and ramus remodeling, suggesting adaptive remodeling rather than relapse. Full article