Search Results (118)

Introduction: Malocclusion and dysfunctional or atypical swallowing are two conditions that significantly affect the health and well-being of the stomatognathic system, so much so that they often interact, influencing each other, and the presence of one can cause the onset or aggravation of the other. In this regard, over the years studies have been carried out that tried to discover the correlation between atypical swallowing and malocclusion. The aim is to evaluate the prevalence of dysfunctional swallowing in patients with malocclusion, to examine the pathophysiological mechanisms linking malocclusion and dysfunctional swallowing, and above all to investigate what potential risk factors may be. Materials and Methods: A sample of 60 patients aged between 6 and 16 years was analyzed at the Department of Dentistry of the University of L’Aquila. Some characteristics of the subjects’ face and posture were analyzed both from a frontal and lateral point of view. An orthodontic, temporomandibular joint, and masticatory muscle diagnosis was made. In addition, an examination of oral structures and functions was performed that allowed breathing, swallowing, chewing, and phono-articulation to be assessed. Results: It was observed that all the children had atypical swallowing, with significant postural abnormalities of the tongue; in fact, only 5% had a correct posture of the tongue at rest. In the analysis of occlusal characteristics, it emerged that with regard to the transverse plane, 21.67% of subjects have a condition of No Cross, while 10% show a Unilateral Cross. Finally, 68.33% show a Bilateral Cross. As far as the anterior–posterior plane is concerned, most of the subjects, equal to 76.67%, are placed in Class I, while 23.33% are in Class II. Finally, in relation to the vertical plane, 63.33% of subjects have normal occlusion, while 25% suffer from deep bite and 11.67% from open bite. The sample, stratified by presence or absence of alerts, shows significant differences for atypical swallowing (p = 0.031), for the presence of Class II malocclusion (p = 0.002), for low lingual posture, (p < 0.001), and for labial incompetence (p = 0.001). The multivariate logistic regression model showed that the presence of atypical swallowing (OR 1.04, 95% CI 1.04–1.07, p = 0.029), open bite malocclusion (OR 1.09, 95% CI 1.01–1.18, p = 0.013), low lingual posture (OR 1.11, 95% CI 1.04–1.18, p = 0.002), and the presence of labial incompetence (OR 1.06, 95% CI 1.02–1.10, p = 0.029) were significant clinical risk factors independently associated with the presence of alerts. Conclusions: The data collected confirm that atypical swallowing is a key element in the development of malocclusions, with a strong impact on posterior crossbite, anterior overjet, and other occlusal discrepancies. Among the data collected in the diagnostic phase, patients who presented at least one significant alert were also considered and atypical swallowing, low lingual posture, open bite malocclusion, and the presence of labial incompetence were statistically significant. Full article

Background: Functional imbalance within the stomatognathic system can develop long before clinical symptoms become evident. Subtle biological changes, such as low-grade inflammation or metabolic disturbance, may precede gingival inflammation, temporomandibular discomfort, or masticatory muscle sensitivity. This study introduces the BioRisk-S (Biological Risk–Stomatognathic System) algorithm, a predictive model designed to identify early systemic alterations associated with the subclinical stage of stomatognathic dysfunction. Methods: A total of 260 clinically healthy adults without apparent stomatognathic disorders were enrolled and evaluated at baseline (T0) and re-examined after six months (T1). Routine laboratory tests were performed to determine high-sensitivity C-reactive protein (hs-CRP), neutrophil-to-lymphocyte ratio (NLR), and 25-hydroxyvitamin D levels. These biomarkers were integrated into the BioRisk-S algorithm to estimate systemic biological imbalance. Follow-up examinations focused on detecting early functional changes, including gingival inflammation, signs of temporomandibular joint (TMJ) dysfunction, and masticatory muscle tenderness. Results: Participants with higher baseline BioRisk-S scores showed significantly higher hs-CRP and NLR values, as well as lower vitamin D levels, indicating a mild but persistent inflammatory profile. After six months, these individuals exhibited early gingival inflammation, muscle tenderness, or mild TMJ discomfort more frequently than those with low BioRisk-S values (p < 0.01). The predictive model demonstrated good accuracy for detecting early biological imbalance preceding clinical dysfunction, with an area under the curve (AUC) of 0.84 (95% CI: 0.78–0.89). Conclusions: The BioRisk-S algorithm represents a feasible, low-cost tool for early systemic screening of functional imbalance within the stomatognathic system. By integrating routine laboratory parameters, this method may help identify individuals at risk before the onset of visible symptoms, supporting preventive and personalized approaches in oral and systemic health management. Full article

Background: Maxillofacial trauma can impair crucial functions of the stomatognathic system. Mandibular condyle fractures, in particular, often lead to temporomandibular joint (TMJ) dysfunction. Methods: This study evaluated the effectiveness of open rigid internal fixation (ORIF) in restoring TMJ function, using the Helkimo Index to compare pre- and post-operative outcomes. Results: A total of 395 patients who underwent ORIF for condylar fractures were analyzed (302 males, 93 females). TMJ function improved significantly from baseline to 6-month follow-up (p < 0.001), with a mean reduction of 2.18 grades on the Helkimo Index. Higher post-operative Helkimo grades (2–3) occurred more frequently during warm months than during cold months (p < 0.05). Low body mass index (BMI) was associated with a greater risk of post-surgical TMJ dysfunction (p < 0.001). TMJ function correlated with facial nerve recovery: patients with poorer pre-operative TMJ function showed additionally slower facial nerve recovery during the first five months after surgery. Age, gender, place of residence, injury characteristics, comorbidities, delay of surgery, duration of surgery, surgical approach, fixing material and laboratory blood tests showed no significant association with post-operative TMJ function. Residual TMJ dysfunction was observed in 3% of treated patients (Di = 3). Conclusions: ORIF, combined with appropriate post-operative physiotherapy, effectively restores TMJ function after condylar fractures—including severe injuries. Simple clinical indices such as the Helkimo Index reliably capture functional improvement. Full article

Background: Posturography is a diagnostic method used to evaluate postural stability by recording body sway and the distribution of pressure on the ground. Temporomandibular disorders (TMDs) involve musculoskeletal and neuromuscular dysfunctions affecting the temporomandibular joint, masticatory muscles, and associated structures. Given the anatomical and functional connections between the stomatognathic system and postural control mechanisms, this study aimed to assess whether TMDs influence body posture and balance as measured by posturographic parameters. Methods: 75 volunteers, aged 19–48, were included. The TMD group (n = 45) was diagnosed based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), and the control group (n = 30) showed no signs of TMD. All participants underwent posturographic assessment and jaw opening range measurement. Posturography was performed using a pressure platform that recorded the center of pressure (COP) in static conditions. Postural stability was assessed using the Romberg test with eyes open and closed. Results: No statistically significant differences were found between the TMD and control groups in COP parameters, including ellipse area (EA) and total load distribution. Within both groups, COP sway increased significantly in the eyes-closed (EC) condition, as reflected by a greater unsteadiness length (UL). In contrast, EA was larger in the eyes-open (EO) condition in both groups, indicating a wider but more controlled spatial dispersion of COP. Intra-group analysis further revealed a significantly higher load on the left side in the control group only. Conclusions: The results do not support a significant postural imbalance in individuals with TMD compared to healthy controls. However, increased sway with eyes closed suggests that visual input plays a key role in postural control, regardless of TMD status. Full article

Background: Mandibular lateral displacement is a common functional occlusal disorder that may occur independently or in conjunction with other types of malocclusion. Substantial evidence indicates that in growing patients, mandibular lateral displacement can have a significant negative impact on the development of both the morphology and function of the stomatognathic system. Early diagnosis and intervention are therefore crucial to preventing a range of developmental abnormalities, including skeletal and soft tissue asymmetries, temporomandibular joint dysfunction, and pathological tooth wear. Aim: The aim of this study is to analyze and systematize current scientific perspectives on the etiopathogenesis of mandibular lateral displacement, as well as approaches to its prevention and early treatment. Methods: A comprehensive review of the literature published between 1980 and 2025 was conducted. Sources were identified through searches in the PubMed, Google Scholar, Elsevier, Web of Science, and SUM Library databases. Results: Mandibular lateral displacement necessitates early diagnosis and timely initiation of orthodontic treatment. The majority of studies addressing the treatment of mandibular lateral displacement are limited to case reports. Conclusions: Further well-designed, longitudinal studies are needed to establish standardized diagnostic criteria and evidence-based treatment protocols for early management of mandibular lateral displacement in growing patients. Full article

Introduction: Acromegaly is a chronic endocrine disorder caused by excessive secretion of growth hormone (GH) and insulin-like growth factor 1 (IGF-1). Acromegaly leads to a wide range of systemic alterations, including metabolic disturbances, abnormalities in bone microarchitecture, soft tissue overgrowth, and morphological changes in the maxilla and mandible. All these factors may significantly complicate the planning and success of implant therapy. Study Aim: This narrative review aimed to critically analyze the impact of acromegaly on bone healing and osseointegration, with particular emphasis on the stability of implant biomaterials, and to assess whether the disease constitutes a contraindication to implant prosthetic treatment. Methods: A narrative literature review was conducted using the PubMed, Scopus, and Web of Science databases, covering publications from 2000 to August 2025. Manual screening of reference lists from key articles was also performed. Peer-reviewed publications in English, including experimental and preclinical studies, case reports, biomaterials research, and conceptual reviews, were included based on their relevance to acromegaly, bone metabolism, stomatognathic alterations, and implant therapy outcomes. No formal inclusion or exclusion criteria were applied, and methodological quality was not formally assessed, reflecting the exploratory and conceptual nature of this review. Results: Patients with acromegaly exhibit persistent structural bone deficits, such as reduced trabecular number, irregular trabecular distribution, and increased cortical porosity, despite normal or even elevated bone mineral density. In parallel, profound changes in soft tissues and dentition are observed, including macroglossia, diastemas, gingival overgrowth, and mandibular prognathism, which further complicate prosthetic rehabilitation. Animal studies suggest that GH and IGF-1 may support early osseointegration, although the long-term effects of their excess remain inconclusive. Clinical data, although limited, indicate that implant placement in patients with acromegaly is feasible when treatment is meticulously planned and carried out within an interdisciplinary setting. Standard biomaterials, such as titanium and its alloys, may undergo degradation under conditions of chronic inflammation and oxidative stress, underscoring the need for innovative solutions integrating bioactive and immunomodulatory materials, as well as patient-specific implants manufactured using 3D printing technologies. Conclusions: Acromegaly should not be regarded as an absolute contraindication to implant therapy; however, the current evidence is limited. Implant placement requires individualized planning, endocrine control, and interdisciplinary coordination. Further clinical and preclinical studies are needed to establish reliable treatment protocols for this population. Full article

Background: Angle’s dental class asymmetries not associated with crossbite are malocclusions that are often underestimated in pediatric patients. However, they may be associated with alterations in the development of the stomatognathic system. Objective: The objective of this study was to evaluate the prevalence of Angle’s class asymmetries without crossbite in primary-school-aged children and to investigate possible associations with perinatal, clinical, and functional variables. Materials and Methods: This cross-sectional observational study analyzed a sample of 391 children aged 6 to 11 years, attending a primary school in the metropolitan area of Milan, Italy. Data were systematically collected through both clinical examination and patient history, with the aim of identifying significant correlations with the occurrence of dental asymmetries in the absence of crossbite. Results. The results revealed a higher prevalence of occlusal asymmetries associated with factors such as oral breathing, low tongue posture, type of delivery, formula feeding, and systemic diseases during the first three years of life. Advanced carious lesions and inclination of the occlusal plane were significantly associated with asymmetry. Conclusions: The study highlights the importance of early diagnosis and a multidisciplinary approach to prevent malocclusions and complex craniofacial dysfunctions later in life. Full article

Background and Objectives: Harmful repetitive oral behaviors impose an excessive load on the stomatognathic system. Being unconscious and involuntary, patients are often unaware of their occurrence and, consequently, of their potential consequences. We aimed to screen the Romanian population for harmful oral habits, while simultaneously emphasizing the importance of employing validated and internationally accepted diagnostic instruments for a better approach to these conditions. Materials and Methods: An observational, descriptive study was conducted on 459 adults, recruited through a multiregional convenience sampling from the general population in Romania. Oral behaviors were assessed using the validated Oral Behaviors Checklist (OBC-21) questionnaire. Data was analyzed using descriptive and comparative statistics, with significance set at p < 0.05. Results: The sample included 363 women (79.1%) and 96 men (20.9%), with a mean age of 33.3 years. The mean total OBC score was 22.45 ± 10.27, indicating a moderate prevalence of oral behaviors. 60.1% of participants were classified as low-risk and 39.9% as high-risk, with none in the no-risk category. The most frequently reported behaviors were sleeping positions exerting pressure on the mandible (57.7% “very often”), sustained talking (11.3%), and nocturnal bruxism (10.5%). Younger adults (20–49 years) presented significantly higher OBC scores compared to both younger extremes (18 years) and older adults (>60 years) (p < 0.001). No significant gender differences were observed in total OBC scores; however, unilateral chewing, sustained talking, and holding objects between the teeth were significantly more frequent among women (p < 0.05). Conclusions: This is the first study to investigate oral behaviors in a Romanian adult population. Postural and involuntary activities were the most prevalent and age influenced OBC scores, while gender differences were limited to individual behaviors. Conducting screening and implementing therapeutic interventions based on the assessed level of risk could enhance the overall management of the condition. Full article

ROGDI-related neurodevelopmental and dental disorder (ROGDI-RD), also known as Kohlschütter–Tönz syndrome (KTZS, MIM #226750), is a rare condition characterized by developmental abnormalities affecting both the central nervous system (CNS) and the dentition. These phenotypes highlight the role of complex gene–environment interactions and developmental networks shared by the nervous and stomatognathic systems, both of which originate mostly from neural crest-derived cells. In this review, we analyze clinical and genetic data from 54 previously reported ROGDI-RD patients to better define the phenotypic spectrum of the disorder. Most of the reported cases harbor protein-truncating variants. Here, we also present the first description of a patient carrying a missense variant in ROGDI atypical leucine zipper gene, ROGDI in trans to a frameshift variant. This individual presented with tooth agenesis—a dental anomaly not previously associated with the syndrome—alongside classic neurological and dental enamel features, suggesting that the phenotypic spectrum of ROGDI-RD may be broader than currently recognized. Using a complexity and network science framework, we discuss how dysregulation in multilevel, interacting developmental systems may explain the pleiotropic features of ROGDI-RD. Our findings underscore the importance of early, interdisciplinary clinical evaluation in patients with neurodevelopmental symptoms and enamel defects. As enamel phenotypes such as amelogenesis imperfecta are heterogeneous, comprehensive genomic analyses and collaborative clinical approaches are essential for accurate diagnosis and improved care. Full article

This narrative review addresses the complexities of managing the vertical dimension of occlusion (VDO) in restorative dentistry, focusing on predictability in prosthetic reconstructions. Altering VDO impacts biological, biomechanical, esthetic, and functional aspects, making it a controversial topic. While VDO naturally evolves throughout life, interventions require careful consideration due to potential complications. Various techniques guide VDO determination, including facial proportions, physiological methods, phonetics, and cephalometric analysis. Clinicians must understand these principles and adapt them to individual patient needs. Materials and Methods: A narrative literature review was conducted using PubMed, Scopus, Google Scholar, and the Cochrane Library, searching keywords like “vertical dimension of occlusion”, “dental”, “diagnosis”, “management” and “complications”. In addition to the literature review, two case reports with extensive prosthodontic restorations were included to illustrate the diagnostic challenges and treatment considerations in a clinical setting. Results: Increasing VDO aids restorative treatments, re-establishing morphology, and facilitating additive procedures. Minimally invasive approaches, provisional restorations, and fixed restorations with functional contours are favored. Individualized, patient-centered care is critical, recognizing unique anatomical and functional needs. This approach optimizes stomatognathic system rehabilitation while preventing adverse effects on body posture and airway dimensions. Conclusions: To ensure predictable results and minimize risks, changes in VDO should be kept to a minimum to achieve dentofacial aesthetic harmony and secure adequate space for the planned restorations The two case reports presented, with different clinical approaches, underline the importance of understanding the potential risks and benefits of VDO alteration which is crucial for achieving predictable and successful outcomes in complex restorative cases. Full article

Background: The hyoid bone is a key anatomical structure involved in the functional coordination of the stomatognathic system. Although its position may vary in response to masticatory patterns, its relationship with functional occlusion remains insufficiently studied in orthodontics. Objective: This pilot study aimed to explore the association between masticatory type and hyoid bone position and to assess the clinical utility of the Functional Masticatory Angle of Planas (AFMP) in classifying masticatory patterns. Materials and Methods: A descriptive, observational, cross-sectional study was conducted with 18 patients. Right and left AFMPs were measured using standardized intraoral photographs, and hyoid bone position was assessed via panoramic radiographs, classified as either aligned or displaced. Measurements were repeated to assess intraobserver reliability. Results: In most cases, hyoid bone elevation occurred on the same side as the smaller AFMP, suggesting a possible adaptive response to unilateral masticatory dominance. High intraobserver agreement was confirmed for both AFMP and hyoid measurements. Conclusions: The findings suggest a potential relationship between functional masticatory asymmetry and hyoid bone position. While further studies with larger samples are needed, the AFMP appears to be a promising tool for evaluating functional occlusion in relation to craniofacial dynamics. Full article

The primary goal of this study was to assess the suitability of the proposed method for modifying the surface of cobalt alloys in dental prosthetics, taking into account the specific characteristics of the stomatognathic system during long-term use and their impact on physicochemical properties and the adhesion of cariogenic bacteria such as Streptococcus mutans. Technological factors influencing the quality of the product and its final dimensional characteristics were considered, confirming or ruling out the possibility of iatrogenic errors (related to poorly shaped prostheses) occurring during laboratory fabrication. This study demonstrates that atomic layer deposition of ZrO₂ on CoCr dental alloys results in a chemically stable, uniform, and protective surface layer, reducing ion release and improving surface quality. These improvements address key safety and performance requirements outlined in MDR 2017/745, supporting the use of ALD as a state-of-the-art technique for functionalizing dental prosthetic devices. Such coating development may influence the final quality of the denture and also verify its suitability for use in the oral environment (reducing the likelihood of denture stomatitis). Full article

Background: Orofacial dysfunctions are a source of discontent and impair daily living activities. Patients with hearing impairments exhibit an elevated risk of stomatognathic system changes. Hence, this pilot study aims to evaluate changes in stomatognathic system functions in patients with hearing impairments and cochlear implants. Methods: During the examination, the Nordic Orofacial Test-Screening was used to assess orofacial functions. The range of motion within the temporomandibular joints was measured using a vernier caliper. A socio-medical study was conducted to collect data regarding the patients, the cochlear implant sides, and the methods of communication. Results: The statistical analysis showed a significant difference in the total NOT-S scores (p < 0.001) and examination scores (p < 0.001) between patients with hearing impairments and the control group. These significant differences of the total NOT-S score and examination score have large effect sizes (r > 0.5). In particular, significant differences were observed in the results of maximum mouth opening (p = 0.006) and right laterotrusion (p = 0.020). Differences were also observed in the answers regarding the method of communication and the examination score of the NOT-S questionnaire (p = 0.040). The 6A of the NOT-S significantly affected the examination score (p = 0.015) and the total NOT-S score (p = 0.037), while the result of section 6B only significantly affected the NOT-S examination score (p = 0.032). Conclusions: Patients with hearing impairments presented orofacial dysfunctions significantly more often than the control group. The side of cochlear implant implantation is important for stomatognathic system changes. Full article

Background/Objectives: Dyslexia and dysgraphia are common childhood neurodevelopmental disorders characterized by persistent reading and writing difficulties, despite normal intelligence and access to education. While typically described as cognitive–linguistic deficits, emerging research suggests potential links to orofacial dysfunction and emotional regulation issues. This study examines associations between stomatognathic anomalies, emotional dysregulation, and early indicators of dyslexia-dysgraphia risk in preschool children, aiming to strengthen early screening and intervention strategies. Methods: A cross-sectional case–control study included 689 Romanian children aged 5–7 from 11 kindergartens. Screening involved the ACTIV-BURLEA psychometric battery to evaluate language, motor, and cognitive abilities. Clinical assessments targeted dental arch form, occlusal balance, and tongue and lip function. Emotional regulation was evaluated using a standardized child behavior scale. Thirty-two children were identified as at risk for dyslexia-dysgraphia and followed longitudinally, and then compared to matched controls. Statistical analysis employed chi-square tests, Pearson correlations, t-tests, and logistic regression. Results: At follow-up, 74.19% of at-risk children received confirmed diagnoses. Tongue dysfunction (TD) (OR = 4.81, p = 0.06) and emotional dysregulation (ED) (OR = 3.94, p = 0.09) emerged as key risk indicators, though not statistically significant. Tongue dysfunction (TD) correlated with school avoidance (r = 0.76, p < 0.01), while occlusal anomalies (OAs) correlated with emotional distress (ED) (r = 0.64, p < 0.05). Conclusions: The findings suggest that early dyslexia-dysgraphia risk involves orofacial and emotional components. Tongue dysfunction (TD), occlusal disturbances (OA), and emotional dysregulation (ED) may offer important clinical markers. Integrating dental and emotional assessments into preschool screening may improve early identification and enable personalized intervention. Full article

Background. Extensive partial edentulism alters the biological and functional balance of the stomatognathic system, requiring targeted pre-prosthetic procedures to optimize treatment outcomes. Objectives. The aim of this study was to assess the extent of improvement in the clinical–biological scores of the prosthetic field in patients with extensive edentulism, following pre-prosthetic interventions. Materials and Method. This prospective, cross-sectional study investigated 194 subjects with extensive partial edentulism. Clinical–biological scores, initially and following the pre-prosthetic phase, were recorded using a scoring system that evaluated dental and periodontal status, bone and mucosal support, occlusion, and mandibulo-cranial relationships. Statistical comparisons of clinical–biological scores were related to the type of prosthetic therapy. Statistical significance was considered at a p-value < 0.05. Results. There was an overall significant improvement in the clinical–biological scores initially (mean value 20.2) and after pre-prosthetic procedures (mean value 23.22) (p < 0.001). When treatment groups were divided, the implant-assisted prosthesis group showed the best improvement in all domains, followed by the conventional fixed-prostheses group (p < 0.01). Dental support improved significantly in those with semi-rigid composite prostheses (p = 0.014), while periodontal support was improved in both fixed- and hybrid-implant groups. Mucosal and bone support improved mostly in the fixed-implant groups (p = 0.014). Conclusions. Pre-prosthetic procedures significantly enhance the biological and functional readiness of the prosthetic field, with the degree of improvement influenced by the complexity and type of planned prosthetic rehabilitation. The findings underscore the value of individualized pre-prosthetic protocols as an essential component of prosthetic treatment planning. Full article