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The severe gummy smile and a skeletal class II profile pose challenges in treatment. This case report outlines an effective alternative for addressing these problems in a patient with skeletal class II division 2, class II molar relationship, retroclination of upper incisors, and lip protrusion. Treatment objectives included normalizing the overjet and overbite, improving the gummy smile, and establishing a satisfactory occlusion. A three-dimensional simulation was performed to consult with the patient, assess possible results, and predict treatment biomechanics. The treatment involved the use of two zygomatic and one inter-radicular temporary anchorage devices, along with botulinum toxin. After the 2-year follow-up, a satisfactory dental occlusion, aesthetic improvement, and adequate function were achieved. This approach offers a viable alternative to orthognathic surgery for adults with skeletal class II malocclusion and a severe gummy smile due to hypermobile lip.

Objective: To determine the relationship of anterior occlusion and skeletal variables with the frontal sinus index., Methods: The retrospective, analytical, cross-sectional, study was conducted from July to November 2020 at Dr Ishratul- Ebad Khan Institute of Oral Health Sciences and Dow Dental College, Dow University of Health Sciences, Karachi, and comprised data from 2015 to 2018 related to pre-treatment lateral cephalograms for determining frontal sinus index and other cephalometric variables. The dental casts were observed for incisor classification. Patients with Class I incisors formed the comparison group, while the rest comprised 5 malocclusion groups. The frontal sinus was traced, and the sinus index was calculated. Data was analysed using STATA 15 and R 3.5.1., Results: Of the 240 subjects, there were 40(16.66%) in each of the 6 groups; 155(64.6%) females and 85(35.4%) males. The mean age of the sample was 21.33±3.52 years (range: 16-29 years). The mean sinus index was higher in all malocclusion groups than the comparison group, but it was significantly higher only in Class II division 2 and anterior open bite groups (p<0.05). The only exception to the trend was Class II division 1 with and without contact in which the value was lower (p>0.05). The anterior cranial base length, sella-nasion mandibular plane angle, and upper incisor palatal plane angle significantly affected the frontal sinus index (p<0.05)., Conclusions: The frontal sinus index could be considered an indicator of harmonious anterior occlusion.

Background: Sex hormones secreted during the menstrual cycle and the application of orthodontic forces to teeth can affect the metabolism of periodontal ligaments. This study aimed to determine whether there are any differences in orthodontic tooth displacement during the menstrual cycle and when using hormonal contraceptives and whether the amount of female sex hormones influences the efficiency of tooth displacement., Methods: A total of 120 women aged between 20 and 30 years with Angle Class II requiring transpalatal arch (TPA) to derotate teeth 16 and 26 were included in this study. The participants were divided into two groups: group A, which included women with regular menstruation, and control group B, which included women taking monophasic combined oral contraceptives. Group A was divided into subgroups according to the moment of TPA activation: menstruation (A1), ovulation phase (A2), and luteal phase (A3) (examination I). On intraoral scans, measurement points were marked on the proximal mesial cusps of teeth 16 and 26, and the intermolar distance (M1) was determined. The change in the position of the measurement points 6 weeks after activation (examination II) made it possible to determine the derotating extent of teeth 16 (O16) and 26 (O26) and the widening of the intermolar distance (M2-M1). In examinations I and II, tooth mobility in the alveoli was assessed using Periotest based on the periotest values (PTV) PTV1 and PTV2, respectively., Results: A significant difference in all parameters was observed among groups A1, A2, and A3 (P < 0.001). Group A3 showed the highest values of parameters O16, O26, and M2-M1, and group A2 showed the lowest values, which did not differ from the control group (P = 0.64). PTV2 and PTV1 were the highest in group A3 and the lowest in groups A1 and B. Intergroup differences were statistically significant (P < 0.001)., Conclusions: With the quantification of changes in tooth mobility in the alveoli during the menstrual cycle in women undergoing orthodontic treatment, it was possible to determine that female sex hormones affect the effectiveness of orthodontic treatment, and the optimal moment for TPA activation is the luteal phase of the menstrual cycle., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Objectives: Anterior open bite can be treated non-surgically via molar intrusion using temporary skeletal devices (TAD). Clear aligner therapy (CAT) is recognized as a viable therapeutic modality for non-extraction treatment of adults with mild open bite. This study aimed to compare the treatment effect and mechanisms of open bite closure between patients treated with braces and TADs double arch intrusion and those treated with CAT. Treatment success at T3 was based on 1- positive overbite on ceph; 2- Change in the vertical dimension 3- post treatment POSI score equal to zero., Material and Methods: The TAD group includes 18 consecutively treated patients from the main author. The CAT group consisted of 16 selected patients from three different orthodontists. The observation time points were as follows: pretreatment (T1), end of molar intrusion and positive overbite achieved (T2), end of treatment (T3), at least 6-month follow-up (T4). Treatment changes were assessed by cephalometric analysis and frontal intraoral photo., Results: At the end of treatment, 100% of the patient of the TAD group and 78,6% of the CAT group had a posi score of 0. The TAD group showed a significant reduction in vertical measurements (SN-MPA: -1,55° ± 0.41, LAFH: -3,05 ± 0.51 mm, U6-PP: -1.48 ± 0.30 mm), but the CAT group did not have significant changes for these variables. Both groups had significant increases in overbite from T1 to T3 (TAD: 4,32 ± 0,5 mm; CAT: 2,33 ± 0.56 mm), and overbite remained stable at T4. The CAT group did not have a significant upper molar intrusion, but a significant extrusion of 1.22 ± 0.42 mm of the lower incisor occurred., Conclusion: The TAD group achieved bite closure by upper molar intrusion, lower molar and incisors vertical control, and mandibular plane counterclockwise rotation, resulting in an improved AP and vertical relationship. The CAT group achieved bite closure through the lower incisor extrusion without significant change in the vertical dimension., Clinical Relevance: This study provides relevant information about the skeletal and dental changes of open bite treatment with TADs double arch intrusion. The comparison with a control group treated with CAT confirms known information., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: The purpose of this study was to analyze and compare the differences in chewing efficiency among patients with different vertical skeletal types of Angle Class I and Angle Class II malocclusions, to provide reference for orthodontic clinical practice., Method and Materials: Sample size estimation revealed a minimum of 53 for each class. Thus, a total of 108 patients with Angle Class I and Angle Class II malocclusions were selected. Lateral skull radiographs were taken, and head measurements were analyzed via geometric tracing software. Chewing efficiency was measured using the gravimetric method to compare between the two groups. The vertical skeletal pattern was classified via Steiner analysis., Results: Significant statistical differences in chewing efficiency were observed between patients presenting with Angle Class I and Angle Class II malocclusions (P < .05). Additionally, significant differences in chewing efficiency were observed among patients with different vertical skeletal patterns (P < .05). Furthermore, a statistically significant difference in chewing efficiency was found between men and women (P < .05)., Conclusions: Patients with Angle Class I malocclusions exhibited significantly higher chewing efficiency compared to those with Angle Class II malocclusions. Among patients with different vertical facial types, the chewing efficiency followed the order of low angle > normal angle > high angle. Moreover, men demonstrated a higher chewing efficiency than women.

Background: Refinements are very common in clear aligner treatments. The aim of this study is to assess whether the predictability of deep overbite correction is similar over several refinements using clear aligners (Invisalign, Align Technology, San Jose, Calif) and examine the accuracy of vertical movement and inclination change of individual teeth., Methods: This retrospective study included 20 deep bite patients (7M and 13F; 32.63 ± 11.88 years old; an initial overbite of 5.09 ± 0.98 mm), consecutively treated from September 2016 and March 2023, who completed at least two sets of aligners, including refinements. The initial, predicted, and achieved models were exported from ClinCheck or OrthoCAD (Cadent Inc, Carlstadt, NJ) and superimposed via best-fit surface-based registration using SlicerCMF (version 4.9.0; cmf.slicer.org). We also examined 15 out of 20 patients who completed treatments. The overbite correction and changes in vertical movement and inclination for individual teeth were measured. Descriptive statistics and a paired t-test or Wilcoxon signed-rank test were performed. P < 0.05 was considered statistically significant., Results: The mean accuracy of overbite correction was 37.63% after 1 st set, followed by 11.19%, 6.32%, and 13.80% (2 nd -4 th sets), respectively. There were statistically significant differences between the predicted and achieved vertical movements and inclination changes for all teeth for the 1 st and 2 nd sets. For the completed cases, the mean overbite correction was 38.54% compared to the initially planned overbite correction, which is similar to one of the 1 st set. Still, the vertical movements and inclination changes of all teeth present statistically significant differences between the initially planned and finally achieved movements except for maxillary lateral incisor torque., Conclusions: The most overbite correction occurs during the 1 st set of aligners, and refinement treatment does not significantly improve the deep bite correction., (© 2024. The Author(s).)

The aim of the present study was to investigate prevalence and association between malocclusion and caries among pre-school children aged 4-6 years frequenting public kindergartens in Shkodër, the largest city in North Albania. The sample for this descriptive and cross-sectional study included 389 pre-school children aged 4-6 years frequenting 20 public kindergartens in Shkodër, the largest city in North Albania. The participants were divided into two groups according to their caries experience evaluated, as determined by decayed-missing-filled index dmf (World Health Organization criteria) score. Those with dmf score of zero were considered to be free of caries. The prevalence of children with at least one malocclusion trait was 89%. The prevalence of caries was 66% (mean dmf score: 3.63). Increased overbite (43%), followed by increased overjet, were the most prevalent malocclusion traits observed in children with a dmf of zero. Among children with caries, the most prevalent trait was increased overjet (42%) and increased overbite. Almost half of the entire study population had a straight terminal plane and class I canine relationship. There was a similar prevalence of bilateral crossbite. Significant changes ( p = 0.008) were observed between the groups with regards to the absence of spacing in the maxillary anterior region. Regression analysis further revealed that children with an absence of maxillary spacing were 2.564-fold more likely to have caries; those with a deepbite were 0.814-fold more likely to have caries. More than half of the children had caries. Increased overjet, overbite, crossbite and maxillary crowding were malocclusion traits observed in the population included in this study. A positive association was identified between maxillary crowding, deepbite and caries. The association between malocclusion and caries, highlights the necessity for an increased awareness of these two conditions that are commonly found among children of pre-school age., Competing Interests: The authors declare no conflict of interest., (©2024 The Author(s). Published by MRE Press.)

Introduction: Despite the popularity of clear aligners, their predictability has not been assessed adequately. Moreover, no study has investigated their effects on numerous dentomaxillary variables. Therefore, this study was conducted for the first time, assessing several new or controversial items. The aim of the study was to evaluate the effects of clear aligners on the vertical position of the molar teeth and the vertical and sagittal relationships of the face., Methods: This preliminary retrospective before-after non-randomized clinical trial was performed on 168 observations of 84 patients (33.60±9.28 years, 54 females) treated with 0.75mm Invisalign appliances. Pretreatment and posttreatment values were measured for: mandibular plane angle, occlusal plane angle, Y-Axis, ANB, facial angle, lower anterior facial height, overbite, and the distances of the molars from the palate and mandibular plane were measured. The alterations in parameters caused by treatment (delta values) were calculated for each measurement. Effects of treatment and some parameters on delta values were analyzed statistically (α=0.05)., Results: Mean±SD of ΔMP-FH, ΔOP-FH, ΔY-Axis, ΔLAFH, ΔNPog-FH, ΔANB, ΔOverbite, ΔSNB, Δ6-PP, Δ7-PP, Δ6-MP, and Δ7-MP were respectively 0.11±1.61, 0.80±1.56, 0.15±1.18, 0.07±0.91, -0.22±1.25, 0.03±0.62, 0.04±1.15, -0.06±1.14, -0.36±0.94, -0.32±1.14, 0.19±0.96, 0.18±1.10. Only the alterations in OP-FH, 6-PP, and 7-PP were significant (P≤0.011). Age, sex, treatment duration, or pretreatment mandibular plane angle were not correlated with any delta values. However, the pretreatment occlusal plane angle was negatively correlated with ΔOP-FH and ΔY-Axis. Crowding was correlated negatively with ΔOP-FH and ΔY-Axis and positively with ΔNPog-FH. Overjet was negatively correlated with ΔANB and ΔOverbite (P≤0.035)., Conclusions: Invisalign intruded first/second maxillary molars and increased the occlusal plane angle. Age, sex, and treatment duration were not correlated with post-treatment anatomic alterations., (© 2024. The Author(s).)

Objective: This study aimed to evaluate the impact of molar teeth distalization movement by clear aligners on changes in the alveolar bone thickness and orthodontically induced inflammatory root resorption (OIIRR) in maxillary molars using conebeam computed tomography (CBCT)., Materials and Methods: Three-dimensional CBCT scans of 35 adult patients (one hundred forty maxillary molars) with pre-designed selection criteria and a mean age of 24.4 ± 7.1 years were included. The measured parameters, including alveolar bone thickness for maxillary molars and root resorption (OIIRR), were analyzed using pre-and post-treatment CBCT (T0 and T1, respectively) with Invivo 6.0 software., Result: Post-treatment, relevant statistically significant changes included deposition of bone in the average palatal surface of the 1st molars. The reduction of bone was seen in the average buccal surface of the first molars and both surfaces of the second molars. Regarding root length after treatment, the average maxillary 1st molar roots showed significant OIIRR (p < 0.001)., Conclusion: Clear aligner treatment could effectively reduce the incidence of alveolar bone thickness reduction and OIIRR in treating Class II malocclusions compared to conventional braces, as shown in previous studies. This research will aid in fully grasping the benefits of clear aligners., (© 2024. The Author(s).)

Introduction: This study aimed to investigate changes in bite force (BF) and occlusal contact area after anterior open-bite (AOB) treatment and compare the changes in surgical vs nonsurgical treatment., Methods: This retrospective study included patients with AOB compared with normal occlusion. AOB was corrected by either intrusion of the maxillary molars (intrusion group, n = 19) or orthognathic surgery (surgery group, n = 37). The control group (n = 35) had a normal overbite relationship. Records of lateral cephalograms, BF, and occlusal contact area taken before (T0), immediately after (T1), and 2 years after (T2) orthodontic treatment were compared within and among the 3 groups., Results: The open-bite group, including intrusion and surgery groups, had a lower BF and less occlusal contact area than the control group at T0 and T1 (P <0.001). However, there were no significant differences among the 3 groups at T2 (P >0.05). The intrusion and surgery groups showed no significant differences throughout the observation period extending from T0 to T2 (P >0.05). Although BF and occlusal contact area decreased at T1 compared with T0, they increased during retention and showed higher values at T2 than at T0., Conclusions: Treatment of AOB improved BF and occlusal contact area 2 years posttreatment. Orthognathic surgery and molar intrusion using orthodontic miniscrews can improve occlusal function similarly. Orthodontists can select either method depending on malocclusion severity and patient demand., (Copyright © 2023 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: To evaluate the change in overbite within an untreated cohort from 9 to 18 years of age and to compare age-related changes in overbite depth based on vertical skeletal proportion., Materials and Methods: Lateral cephalograms were obtained from the American Association of Orthodontists Foundation (AAOF) Craniofacial Growth Legacy Collection Project. All cephalometric outcome measures were assessed at ages 9-11 (T1), 13-15 (T2), and 17-19 (T3) years. Generalized estimating equation (GEE) regression models were fit to examine the effect of MP-SN on overbite adjusted for age and gender., Results: A total of 130 subjects from the Denver, Bolton Brush, and Oregon Growth Studies were included. Overbite was relatively constant from T1 to T3 irrespective of facial type, with a minor decrease (0.15 mm) being observed overall. There was a transient increase between T1 and T2 (0.31 mm) that was canceled out by changes during later adolescence. Based on the GEE regression model adjusted for time and gender, a minor but statistically significantly greater reduction in overbite arose as MP-SN increased (coefficient = -0.080; 95% confidence interval -0.12, -0.04; P < .01)., Conclusions: In hyperdivergent subjects, a marginal decrease in overbite was observed from 9 to 18 years of age, with a transient increase from the period spanning 9-11 years to 13-15 years, which was negated in later adolescence. There are limited data to suggest that observation of vertical growth is required in most patients with marginally increased vertical facial proportions in the juvenile and pubertal phases., (© 2024 by The EH Angle Education and Research Foundation, Inc.)

Introduction: This study aimed to examine the stability of anterior open bite (AOB) treatment with clear aligners., Methods: This retrospective cohort study included 52 adult AOB patients (aged >18 years; 15 males, 37 females) who underwent nonextraction clear aligner treatment and were at least 1 year posttreatment. Eleven cephalometric measurements were evaluated at pretreatment, end of active treatment, and at least 1-year posttreatment. Overbite change, the primary outcome variable, and other cephalometric changes during treatment and retention were calculated, and repeated measures analysis of variance were performed. Stepwise multiple regression was used to make a prediction equation for open bite relapse., Results: The mean retention period was 2.1 ± 1.1 years. The mean change in overbite during treatment was 3.3 ± 1.5 mm; 6% of patients presented relapse at least 1 year after treatment completion. The mean change of overbite (0.2 ± 0.5 mm) during the retention period was not statistically significant (P = 0.59). None of the 11 cephalometric measurements showed significant change during the retention period. The prediction model showed that only the coefficient for a tongue posture issue at the initial examination was statistically significant., Conclusions: AOB was successfully corrected in all 52 patients using only clear aligners with no additional adjunctive aids such as microimplants. When retained with maxillary and mandibular fixed retainers and maxillary and mandibular vacuum-formed retainers, there was no significant change in cephalometric measurements during the short-term retention period., (Copyright © 2023 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objective: This systematic review and meta-analysis aimed to assess the effect of premature loss of primary teeth in children of mixed dentition age on the prevalence of malocclusion in permanent dentition., Material and Methods: A search was conducted in Medline through PubMed, Cochrane databases, Google Scholar, and Directory of Open Access Journals (DOAJ) through March 2023. All observational studies that evaluated the association between premature loss of primary teeth and malocclusion in permanent dentition were included for analysis. Quality of studies was evaluated using the Newcastle-Ottawa tool. Meta-analysis was conducted using Cochrane Review Manager (RevMan) Version 5.3. The association between different categories of malocclusion and premature loss of primary teeth was assessed using a random-effects model. Heterogeneity was explored through sensitivity analysis. Certainty of evidence was evaluated using GRADE analysis., Results: This meta-analysis showed that the premature loss of primary teeth significantly increases the prevalence of overall malocclusion in permanent dentition (OR=2.54, P=0.003; I 2 : 83%). Subgroup analysis showed an insignificant relationship of premature loss of primary teeth with Class I malocclusion (OR=1.14, P=0.45; I 2 : 63%) and Class II malocclusion (OR=1.63, P=0.18; I 2 : 87%) but statistically significant relationship with Class III malocclusion (OR=3.73, P=0.006; I 2 : 71%). Sensitivity analysis reflected a significant reduction in I 2 values., Conclusion: This meta-analysis provides substantial evidence supporting the relationship between premature loss of primary teeth and malocclusion in permanent dentition. Notably, Class III malocclusions exhibited a significant association with premature loss of primary teeth., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Background and Objective: The genetic basis of dentoalveolar characteristics has been investigated by several studies, however, the findings are equivocal. The objective of this systematic review and meta-analysis was to evaluate the heritability of dental arches and occlusal parameters in different stages of human dentition., Search Methods: Electronic databases PubMed, Embase, Scopus, Web of Science, and Dentistry and Oral Science Source were searched up to August 2023 without the restriction of language or publication date., Selection Criteria: Empirical studies investigating the heritability of dentoalveolar parameters among twins and siblings were included in the review., Data Collection and Analysis: Study selection, data extraction, and risk of bias assessment were performed independently and in duplicate by two authors and a third author resolved conflicts if needed. Joanna Briggs Institute's critical appraisal tool was used to evaluate the risk of bias among studies and the certainty of evidence was assessed using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) criteria., Results: Twenty-eight studies were included in the systematic review, of which 15 studies reporting heritability coefficients in the permanent dentition stages were deemed suitable for the meta-analysis. Random-effects meta-analyses showed high heritability estimates for maxillary intermolar width (0.52), maxillary intercanine width (0.54), mandibular intermolar width (0.55), mandibular intercanine width (0.55), maxillary arch length (0.76), mandibular arch length (0.57), and palatal depth (0.56). The heritability estimates for the occlusal parameters varied considerably, with relatively moderate values for crossbite (0.46) and overbite (0.44) and low values for buccal segment relationship (0.32), overjet (0.22), and rotation and displacement of teeth (0.16). However, the certainty of evidence for most of the outcomes was low according to the GRADE criteria., Conclusions: Based on the available evidence, it can be concluded that the dental arch dimensions have a high heritability while the occlusal parameters demonstrate a moderate to low heritability., Registration: PROSPERO (CRD42022358442)., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Orthodontic Society.)

Objective: The objective of this study was to examine the relative contributions of genetic and environmental influences on variation in dental arch form in individuals who have largely completed their craniofacial growth., Material and Methods: The subjects of this study comprised dental casts of 50 monozygotic twins and 24 dizygotic twins from the collection of records of twins housed at the Adelaide Dental School, Australia. The subjects were of Western European descent, with an average age of 20.93 ± 5.58 years. Dental casts were scanned using a 3D scanner to analyse the dental arch form. Landmark-based inter-arch and intra-arch measurements were performed. Structural equation modelling was employed to analyse the quantitative data using the normal assumptions of the twin model., Results: Genetic modelling revealed that additive genetic and unique environmental factors best explained the observed variation for all occlusal traits measured, except for mandibular intercanine width. High heritability was observed for most intra-arch occlusal variables (0.61-0.85) including the maxillary and mandibular intercanine and intermolar widths, arch depth and perimeter. In contrast, moderate heritability was found for inter-arch occlusal variables (0.52-0.59) such as overjet and overbite. Sexual dimorphism was evident, with males displaying larger posterior arch width than females (P < 0.05)., Limitations: Our sample was limited to individuals of Western European ancestry., Conclusion: The predominant source of occlusal variation within this group of Australian twins of Western European descent was controlled by genetic effects, and most were highly heritable. Generally, intra-arch occlusal variables showed greater heritability compared with inter-arch occlusal variables., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Orthodontic Society.)

Background: An increasing number of patients with advanced stages of periodontitis are seeking for treatment options. The study aimed to determine interest in orthodontic treatment (OT) and its association with oral health status and knowledge about the disease in adult subjects with stage III-IV periodontitis., Methods: 96 subjects ≥ 30 years, with stage III-IV periodontitis agreed to fill in a questionnaire and undergo a comprehensive periodontal-orthodontic examination. The questionnaire included 44 questions: demographic, dental, health related habits, self-perceived overall and oral health, knowledge of periodontitis, and attitude toward OT. The statistical analysis was performed using a paired-sample T-test, Receiver Operating Characteristic (ROC) and binary logistic regression analysis (LRA)., Results: Stage IV periodontitis was observed in 32.3% of subjects and Class II malocclusion was most prevalent (53.1%). More than half of subjects were interested in OT. Oral health, knowledge about periodontitis and age were significant predictors for interest in OT., Conclusions: Knowledge spread about OT possibilities in advanced stages of periodontitis is very important both for the dental community and older subjects to save natural dentition., (© 2023. The Author(s).)

Objectives: To compare changes in maxillary molar root resorption, intrusion amount, dentoskeletal measures, and maximum bite force (MBF) between clear aligners (CA) and fixed appliances with miniscrew (FM) during molar intrusion., Materials and Methods: Forty adults with anterior open bite were randomized into either CA or FM groups. Lateral cephalograms, cone-beam computed tomography (CBCT), and MBF were collected at pretreatment (T0) and 6 months of treatment (T1). Maxillary molar intrusion in FM were intruded by nickel-titanium (NiTi) closed-coil spring delivered force (150 grams/side) while clear aligners combined with squeezing exercise were performed in CA. Parametric tests were used for statistical analysis., Results: After 6 months of treatment, significant root resorption of 0.21-0.24 mm in CA and 0.38-0.47 mm in FM were found while maxillary molars were intruded 0.68 and 1.49 mm in CA and FM, respectively. CA showed significant less root resorption and intrusion than FM. Overbite, bite closing, and MBF increased significantly. CA showed significantly less overbite and SN-MP changes but more MBF increase than FM. MBF in CA was correlated with the amount of maxillary molar intrusion (r = 0.736, P < .05)., Conclusions: Maxillary molar intrusion and root resorption in CA were half the amount in FM in 6 months. The amount of maxillary molar root resorption was one-third of the intrusion distance. CA displayed less overbite increase and bite closing but more MBF increase than FM. MBF in CA was positively correlated with the molar intrusion amount., (© 2023 by The EH Angle Education and Research Foundation, Inc.)

Objectives: To evaluate whether the quality of orthodontic finishing influences long-term stability of anterior tooth alignment., Materials and Methods: This retrospective study evaluated 38 patients. Data were obtained at the beginning of treatment (T0), at the end (T1), and at least 5 years after T1 (T2). At this point, the individuals were no longer wearing retainers. Anterior tooth alignment was measured using Little's index (LI). Effect on alignment stability was tested with multiple linear regression using LI-T0, LI-T1, intercanine width difference T1-T0, overbite (T1), overjet (T1), age, gender, time without retention, and presence of third molars as predictor variables. Well-aligned (LI < 1.5 mm) and misaligned (LI > 1.5 mm) cases were compared at T2., Results: At T2, the alignment stability in the upper arch was inversely associated with the alignment quality (R2 = 0.378, P < .001) and directly associated with overbite (R2 = 0.113, P = .008) at T1. Posttreatment changes caused cases finished with poor alignment to become similar to those finished with excellent alignment (P = .917). In the mandible, posttreatment changes were directly associated only with overjet (R2 = 0.152, P = .015) and well-finished cases displayed better alignment than poorly finished cases (P = .011). Other variables showed no significant association., Conclusions: In arches without retention, better quality of orthodontic finishing does not guarantee the stability of anterior alignment. In the maxilla, long-term changes were more significant the greater the overbite and the better the quality of alignment at end of treatment. In the mandible, changes were not dependent on the quality of finishing but were associated with greater overbite at T2., (© 2023 by The EH Angle Education and Research Foundation, Inc.)

Introduction: Tooth size ratio is important for optimal dentofacial esthetics, occlusal interdigitation, and postorthodontic treatment stability. Tooth geometry influences tooth size ratio; therefore, tooth size normative data may not be practical across diverse ethnic groups. This study aimed to determine whether there are significant differences in 3-dimensional tooth size among patients in the Hispanic population with Angle Class I, II, and III malocclusions., Methods: The data were collected using intraoral scanned orthodontic study models representing Hispanic orthodontic patients with Angle Class I, II, and III malocclusions. The scanned models were digitized and transferred to a geometric morphometric system. Tooth sizes were determined, quantified, and visualized using contemporary geometric morphometric computational tools., Results: Tooth size was determined for all teeth and showed a significant difference in 4 out of 28 teeth: Maxillary right first molar, mandibular left second molar, mandibular right first molar and mandibular right second molar. This significant difference was noted among females and affected different malocclusion groups., Conclusions: Tooth size discrepancy in the Hispanic population varies among malocclusion groups, and the variation is determined by the participant's gender., (Copyright © 2023 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: To investigate the post-treatment stability of anterior open bite (AOB) cases treated with upper and lower extrusion arches in adults., Materials and Methods: 23 patients with AOB were treated with extrusion arches and evaluated for dentoskeletal changes using lateral cephalometric radiographs before treatment (T0), after treatment (T1), and 12 months post-treatment (T2). Patients received bondable tongue spurs and vacuum-formed retainers as post-treatment retention/stability measures for 12 months. Post-treatment stability was further assessed qualitatively by the Photographic Openbite Severity Index., Results: All the cases showed positive overlap between the anterior teeth at the end of orthodontic treatment, and 20 of 23 treated patients attended the recall visit after 12 months. A total of 85% of the cases maintained positive overlap at least 1 year post-treatment, 10% showed edge-to-edge bite, and only 5% showed no overbite., Conclusions: Treatment of AOB in adults with extrusion arches proved to be stable 1 year post-treatment. Changes in the overbite after 1 year of follow-up were not significant., (© 2023 by The EH Angle Education and Research Foundation, Inc.)

Objective: To evaluate whether there is a difference between the effects of Bionator and Forsus appliances on airway volume., Methods: Forty patients with mandibular retrognathia were divided into two groups. The Bionator appliance was applied to Group 1, while the Forsus FRD EZ2 appliance was applied to Group 2. Three-dimensional images were captured before and after functional appliance use in both groups. Dolphin 3D software was used for airway measurements., Results: No statistically significant difference was found between the groups in terms of volumetric and area measurements. There was a statistically significant difference between the minimum axial T and O-N border T measurements of the groups., Conclusion: The use of functional appliances may contribute to an increase in oropharyngeal airway dimensions, but there was no difference between the Bionator and Forsus groups in terms of volumetric measurements.

Purpose: To compare the treatment effects of clear aligners and customized lingual appliance on treating bimaxillary dentoalveolar protrusion patients with first premolar extractions., Methods: Fifty-four patients with bimaxillary dentoalveolar protrusion treated in Shanghai Ninth People Hospital were involved in the retrospective study. Twenty-five cases used clear aligners and 29 cases used customized lingual appliance. All of them were treated by extracting 4 first premolars and retracting anterior teeth with strong anchorage. The changes of anterior tooth and soft tissue adduction before and after treatment were compared by lateral cephalometric measurements. SPSS 26.0 software package was used for data analysis., Results: The total course of treatment in the clear aligners group (46.32±7.37 months) was about 10.8 months longer than that in the customized lingual appliance group (35.55±5.90 months) (P＜0.05). There was no significant difference in upper incisor retraction, lower incisor inclination and overjet reduction between the two groups(P＞0.05). There were significant differences in upper lip retraction, lower lip retraction, upper incisor torque reduction, and overbite reduction between the two groups(P＜0.05). Customized lingual appliance group showed a significant improvement of lips retraction and overbite reduction in orthodontic treatment. For the correction of overjet, there was no significant difference between the two groups (P=0.337). The data of U1-OP (the distance between edge of the upper central incisor and the functional occlusal plane) was not in normal distribution, and there was no significant difference between the two groups(P=0.184)., Conclusions: The two techniques can both retract the anterior teeth and lips to improve the profile. However, the customized lingual appliance was more effective in improving the soft tissue profile of patients with bimaxillary dentoalveolar protrusion, with shorter treatment course.

Introduction: The objective of this study was to evaluate and compare the 3-dimensional (3D) aging changes of the lips among adult skeletal Class I, II, and III malocclusion., Methods: Female adult orthodontic patients aged 20-50 years with pretreatment cone-beam computed tomography scans were retrospectively classified according to age (20s [20-29 years], 30s [30-39 years], and 40s [40-49 years]) and then subclassified by malocclusion into skeletal Class I, II, and III relationship (9 groups; n = 30 per group). Positional differences in midsagittal and parasagittal soft-tissue landmarks and 3D morphologic aging changes of the lips were evaluated using cone-beam computed tomography scans., Results: Labiale superius and cheilion for patients in their 40s indicated a significant downward and backward position compared with those in their 20s, regardless of skeletal classifications (P <0.05). Accordingly, the upper lip height decreased, and the mouth width increased significantly (P <0.05). For Class III malocclusion, the upper lip vermilion angle was greater for patients in their 40s than those in their 20s (P <0.05), whereas the lower lip vermilion angle was only lower for patients with Class II malocclusion (P <0.05)., Conclusions: Middle-aged adult females (40-49 years) had a lower upper lip height and greater mouth width than those in their 20s, regardless of skeletal malocclusion. However, prominent morphologic aging changes of the lips were noted on the upper lip for skeletal Class III malocclusion and the lower lip for skeletal Class II malocclusion, implying that the underlying skeletal features (or malocclusion) may influence 3D aging changes of the lips., (Copyright © 2023 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

The digital articulation of dental models is gradually replacing the conventional physical approach for occlusal prediction planning. This study was performed to compare the accuracy and reproducibility of free-hand articulation of two groups of digital and physical dental models, 12 Class I (group 1) and 12 Class III (group 2). The models were scanned using an intraoral scanner. The physical and digital models were independently articulated 2 weeks apart by three orthodontists to achieve the maximum inter-digitation, with coincident midlines and a positive overjet and overbite. The occlusal contacts provided by the software color-coded maps were assessed and the differences in the pitch, roll, and yaw were measured. The reproducibility of the achieved occlusion of both the physical and digital articulation was excellent. The z-axis displayed the smallest absolute mean differences of 0.10 ± 0.08 mm and 0.27 ± 0.24 mm in the repeated physical and repeated digital articulations, respectively, both in group 2. The largest discrepancies between the two methods of articulation were in the y-axis (0.76 ± 0.60 mm, P = 0.010) and in roll (1.83° ± 1.72°, P = 0.005). The overall measured differences were< 0.8 mm and< 2°. Despite the steep learning curve, digital occlusal planning is accurate enough for clinical applications., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: To investigate the accuracy of torque, tip and rotation and linear intra-arch movements yielded by passive self-ligating lingual straight-wire appliances with brackets featuring square slots., Materials and Methods: Twenty-five adult Caucasian patients (16 females and 9 males; mean age 26.5 ± 4.3 years) with Class I or mild Class II head-to-head malocclusion were orthodontically treated via passive lingual self-ligating straight-wire appliances (ALIAS, Ormco, Orange, CA) with no extraction. Records were retrospectively analysed, and digital models of pre-treatment (T0), planned (T1) and achieved (T2) phase were acquired for both arches in each patient via an intraoral scanner (Medit I500 (iScan Medit, Seoul, Korea). VAM software (Vectra, Canfield Scientific, Fairfield, NJ, USA) was used to measure both angular values (torque, tip and rotation) and linear intra-arch widths (between canines, first and second premolars and first and second molars). Measurements were obtained for all the movements investigated for each tooth group (incisors, canines, premolars and molars), by arch (maxillary and mandibular) and for both arches at T0, T1 and T2. The accuracy of angular values was compared using Student's t-test against a hypothetical 100%, and among the various tooth groups by post-hoc tests. Transverse linear measurements were investigated by means of the non-parametric Friedman test. The significance threshold was set at 0.05., Results: The mean accuracy of angular values was 77.25 ± 7.71% for torque, 78.41 ± 6.17% for tip and 77.99 ± 6.58% for rotation. In all cases, however, there was a significant difference between planned and achieved movements, and accuracy was significantly lower than the hypothetical 100% for all tooth groups, individual arches and dentition (p < 0.001). For intra-arch diameters, the greatest accuracy values were found for the anterior sectors (83.54 ± 5.19% for the maxillary inter-canine distance) and the lowest for the posterior sectors (67.28% for the maxillary inter-second molar distance)., Conclusion: Straight-wire lingual treatment with passive self-ligating appliances featuring with square slot displayed excellent clinical accuracy, albeit with statistical accuracy decreasing antero-posteriorly., (© 2023. Italian Society of Orthodontics.)

Objectives: The aim of this article is to establish a comprehensive nationwide prevalence of malocclusion traits on the sagittal, vertical, and transverse planes of space in the Turkish population., Material and Methods: A systematic search of PubMed, Scopus, and Web of Science was supplemented by manual searches of Google Scholar and the reference lists of included studies. Original Turkish health studies of any age were included. Strengthening the Reporting of Observational Studies in Epidemiology assessed study quality and bias (STROBE). Sagittal, vertical, and transverse malocclusion features were retrieved and gathered., Results: Eleven studies were selected from 434 titles. Two studies showed a high risk of bias, eight low and one moderate. Thirteen thousand two hundred seventy-one individuals were investigated from early childhood to late adulthood. Most studies were sampled from universities and dental (nonorthodontic) clinics. The pooled malocclusion prevalence was 56% for Class I (95% confidence interval (CI): 44-68%), 31% for Class II (CI: 6-42%), and 11% for Class III (CI: 21-37%). The other common types of malocclusions were crowding (41%, CI: 18-65%), overjet (34%, CI: 21-50%), negative overjet (13%, CI: 7-20%), and crossbite (11%, CI: 7-15%). Additionally, there was no significant difference in Class I (relative risk [RR] = 1.00, [0.96-1.05]), Class II ([RR] = 0.97, [0.92-1.03]), and Class III ([RR] = 1.08, [0.96-1.225]) malocclusion by gender., Conclusions: This study showed Class I malocclusion has a high prevalence among the Turkish population followed by Class II and Class III malocclusions. In addition, crowding and overjet were the most prevalent malocclusions among Turkish individuals. There were no significant differences in the prevalence of malocclusions between males and females., (© 2023 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Objective: To assess volume and surface of the mandibular condyle on cone beam computed tomography (CBCT) scans by comparing Class I, II, and III malocclusions., Methods: CBCT scans of 55 patients were assessed to measure ANB angle, condyle volume, and surface by using VistaDent software. The values were compared between the different skeletal malocclusions and correlated to gender and sides. Kruskal-Wallis test was used for comparison of malocclusions and Mann-Whitney test and Wilcoxon test for comparisons of genders and sides. Statistical significance was defined as p < 0.05., Results: There were no significant differences in volume ( p = 0.588) and surface ( p = 0.830) between the malocclusion classes. The comparison between sides showed a statistically significant difference for surface ( p = 0.038)., Conclusion: Condylar volume and surface evaluated on CBCT scans showed no statistically different values for Class I, II, and III malocclusions.

Objective: It is essential to be aware of the potential effects of orthodontic treatment on tissues and anatomical structures associated with the masticatory system, especially the temporomandibular joint (TMJ). Little information is available about the consequences of molar distalization on the TMJ. Therefore, this study is aimed at investigating the changes of the condyle-fossa relationship after molar distalization using the distal jet appliance., Materials and Methods: The sample consisted of twenty-five patients (mean age 20.4 ± 2.6) who underwent molar distalization by the distal jet appliance. CBCT scans were taken before (T0) and after (T1) the completion of the molar distalization. Joint spaces (anterior, superior, and posterior) and cephalometric vertical angles (SN.GOME and Björk sum) were measured and compared at T0 and T1., Results: Superior and posterior joint spaces increased significantly after molar distalization (PS 0.29 mm, P < 0.001, SS 0.06 mm, P < 0.5). Vertical cephalometric angles also increased after molar distalization by the distal jet appliance (SN.GOME 0.92°, Björk 1.11°)., Conclusion: There was a statistically significant increase in the superior and posterior joint spaces after molar distalization. However, this increase may not be of clinical importance. The vertical dimension has also increased., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 Dani Abo Samra et al.)

Purpose: To investigate the difference in the retention effect of 3D printing resin splint and Hawley retainer combined with lingual retention wire in periodontal disease patients after orthodontic treatment., Methods: Forty patients who finished orthodontic treatment for periodontal disease from January 2021 to February 2022 were selected and divided into experimental group and control group according to the random number table method, with 20 patients in each group. Patients in the experimental group used 3D printing resin splint for retention, while patients in the control group used Hawley retainer combined with a lingual retention wire for retention. The chair-side operation time of the retainers was recorded for both groups. The maxillary and mandibular cuspid width, molar width, overjet, overbite and irregularity index were measured at 1 month and 6 months after orthodontic treatment in both groups. Statistical analysis was performed with SPSS 12.0 software package., Results: The mean time for chair-side manipulation of experimental group and control group was 8.23, 11.17 min, respectively. The difference between the two groups was statistically significant (P＜0.05) when comparing the width of the maxillary and mandibular cusps, the width of the molars, overjet, overbite and the irregularity index after 1 month and 6 months of wear of the retainers, which were significantly greater in the experimental group than in the control group at 6 months(P＜0.05)., Conclusions: 3D printing resin splint, with short chair-side manipulation time, was more effective than Hawley retainer combined with a lingual retention wire, and the efficacy of both groups was otherwise generally consistent.

Background: Clear aligners are reported to control anterior open bites. Despite this, anterior extrusion remains difficult with aligners. Optimized extrusion attachments on incisors may facilitate anterior extrusion to correct open bite with Invisalign. The aim of this retrospective study was to compare the efficacy of anterior open bite correction with Invisalign when using optimized extrusion versus conventional attachments., Methods: This was a retrospective cohort study. The pre- and post-treatment intraoral scans of patients with anterior open bite treated with Invisalign aligners were assessed. Patients were divided into two groups: group A, patients with horizontal conventional attachments and group B, patients with optimized extrusion attachments on incisors. The pre and post-treatment overbite and the planned overbite change were measured and compared between the groups. Descriptive statistics were computed and statistical significance was set at P < 0.05., Results: A total of 86 patients were included. Both groups showed significant increases in overbite, but there was no difference in the open bite correction efficacy in patients with conventional versus optimized attachments. Shorter treatment times for open bite closure were reported for patients with optimized attachments., Conclusions: Anterior open bite can be corrected regardless of the attachment type. Optimized attachments are no more effective than using conventional attachments in incisor extrusion to correct open bite. Patients with anterior open bite with optimized attachments observed shorter treatment times for overbite correction. When correcting anterior open bite with Invisalign, the attachment type does not improve the success rate. Optimized extrusion attachments on incisors may shorten the treatment time compared to conventional attachments., (Copyright © 2023 World Federation of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The aim of this study was to investigate the relationship between occlusal contacts, overbite, transverse expansion, and the buccolingual inclination of the teeth with reference to the predicted treatment outcomes and achieved outcomes related to the use of the Invisalign® appliance in mild-to-moderate Class I malocclusions., Material and Methods: The occlusal contacts, overbite, the buccolingual inclination and transverse expansion of the maxillary arch of adult patients satisfying inclusion and exclusion criteria were measured at the initial (pre-treatment), predicted, and achieved treatment stages using metrology software. Pearson correlation coefficients and regression equations were calculated to determine the association between the initial, predicted and achieved changes in occlusal contact against the other variables., Results: Thirty-three patients, who commenced treatment between 2013 and 2018 and satisfied inclusion/exclusion criteria were evaluated. An overall loss of posterior contact was recorded and highlighted by a significantly greater loss of contact from the maxillary buccal occlusal surfaces compared to the palatal occlusal surfaces. The mean [SD] achieved overbite outcome (2.94mm [1.17]) was greater than the predicted (1.74mm [0.87), P<0.001). The buccolingual inclination was significantly increased for the lateral incisors and first and second molars despite a predicted decrease (P≤0.007). Achieved transverse expansion showed significant variation from the predicted. The loss of posterior occlusal contact was correlated with the buccolingual inclination (r=0.70) and transverse expansion (r=0.74) of the posterior teeth., Conclusions: In mild-to-moderate Class I malocclusions, treatment using the Invisalign® appliance resulted in an overall loss of posterior contact. The loss of occlusal contact was correlated with deficiencies in achieved buccolingual inclination and transverse expansion of the posterior teeth. Planned bodily expansion was ineffective as most expansion occurred due to unplanned buccal tipping., (Copyright © 2023 CEO. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: In an ideal clinical setting, orthodontic therapy with clear aligners (CA) should improve the patients' initial malocclusion and must guarantee equivalence between the results predicted and those obtained clinically to be considered an effective treatment. Therefore, this scoping review aimed to identify the orthodontic literature concerning the effectiveness and predictability of CA treatments., Methods: A systematic computerized search was performed in 3 databases: PubMed, Scopus, and Embase. Inclusion criteria selected observational and clinical studies performed in at least 10 adult orthodontic patients, whose results of CA treatment's effectiveness and/or predictability were assessed., Results: The 3 database computerized searches resulted in 1,553 articles, and 169 full texts were considered potentially relevant. After applying the eligibility criteria, 33 studies were included. Most studies (76%) were designed as cohort studies and have been published in the last 5 years (79%). The majority included only non-extraction treatments (73%), and 79% reported results achieved with the Invisalign® system. The most predictable movement was the buccolingual tipping, while the least predictable movements were rotation, intrusion, and extrusion. Aligner treatment was effective for mild to moderate crowding resolution, and the success of overbite correction still seems to be limited., Conclusions: The studies have demonstrated improvement of initial malocclusion through CA treatments. Still, predictability degree is overestimated and does not accurately reflect the occlusion immediately at the end of treatment. In future studies, there should be an effort to broaden the utilization of alternative aligner systems beyond Invisalign® and broadly disseminate their outcomes to strengthen clear aligners evidence base., (Copyright © 2023 CEO. Published by Elsevier Masson SAS. All rights reserved.)

Objective: The objective of this two-arm parallel randomized controlled trial was to evaluate the treatment effects and lip profile changes in skeletal Class II patients subjected to premolars extraction treatment versus fixed functional treatment., Methods: Forty six subjects fulfilling inclusion criteria were randomly distributed into Group PE (mean age 13.03±1.78 years) and Group FF (mean age 12.80±1.67 years) (n=23 each). Group PE was managed by therapeutic extraction of maxillary first premolars and mandibular second premolars, followed by mini-implant-supported space closure; and Group FF, by fixed functional appliance therapy. Skeletal, dental, and soft-tissue changes were analyzed using pre and post-treatment lateral cephalograms. Data obtained from this open label study was subjected to blind statistical analysis., Results: Extraction treatment resulted in greater increase of nasolabial angle (NLA: 3.1 [95% CI 2.08, 4.19], p<0.001), significant improvement of upper lip (UL-E line: -2.91 [95% CI -3.54, -2.28], p<0.001, UL-S line: -2.50 [95% CI -2.76, -2.24], p<0.001, UL-SnPog': -2.32 [95% CI -2.90, -1.74], p<0.01) and lower lip position (LL-E line: -0.68 [95% CI -1.36, 0.00], p<0.01, LL-S line: -0.55 [95% CI -1.11, 0.02], p<0.01, and LL-SnPog': -0.64 [95% CI -1.20, -0.07], p<0.01), lip thickness (UL thickness: 2.27 [95% CI 1.79, 2.75], p<0.001; LL thickness: 0.41 [95% CI -0.16, 0.97], p<0.01), upper lip strain (UL strain: -2.68 [95% CI -3.32, -2.04], p<0.001) and soft tissue profile (N'-Sn-Pog': 2.68 [95% CI 1.87, 3.50], p<0.01). No significant difference was observed between the groups regarding skeletal changes in the maxilla and mandible, growth pattern, overjet, overbite, interincisal angle and soft tissue chin position (p>0.05). Premolar extraction treatment demonstrated significant intrusion-retraction of maxillary incisors, better maintenance of maxillary incisor inclination, and significant mandibular molar protraction; whereas functional treatment resulted in retrusive and intrusive effect on maxillary molars, marked proclination of mandibular anterior teeth, and significant extrusion of mandibular molars. Both treatment modalities had similar treatment duration. Implant failure was seen in 7.9% of cases, whereas failure of fixed functional appliance was observed in 9.09% of cases., Conclusions: Premolar extraction therapy is a better treatment modality, compared to fixed functional appliance therapy for Class II patients with moderate skeletal discrepancy, increased overjet, protruded maxillary incisors and protruded lips, as it produces better dentoalveolar response and permits greater improvement of the soft tissue profile and lip relationship.

Objective: The primary objective was to compare round multi-strand wire and Ortho-Flex-Tech™ rectangular wire retainers in terms of gingival health. The secondary objectives were to assess plaque/calculus accumulation, and to determine the effectiveness of these retainers in maintaining tooth alignment and their failure rate., Material and Methods: This single-center study was a two-arm parallel randomized clinical trial and was conducted at the Orthodontic clinics in Dental Teaching Center/Jordan University of Science and Technology. Sixty patients, with bonded retention for the mandibular anterior segment after fixed orthodontic treatment, were randomly selected. The sample comprised Caucasian patients with mild to moderate pretreatment crowding in the mandibular anterior region, Class I relationship, treated without extraction of mandibular anterior tooth. In addition, only patients presenting normal overjet and overbite after treatment were included., Intervention: One group received round multi-strand wire retainer (30 patients, average age: 19.7 ± 3.8 years), while the other group received Ortho-Flex-Tech™ retainer (30 patients; average age: 19.3 ± 3.2 years). In both groups, the retainers were bonded to all mandibular anterior teeth from canine to canine. All patients were recalled one year after bracket debonding. Randomization sequence was created using Excel 2010, with a 1:1 allocation, using random block size 4. The allocation sequence was concealed in sequentially numbered, opaque and sealed envelopes. Only participants were blinded to the type of bonded retainer used. The primary outcome was to compare the gingival condition between the two groups. The secondary outcomes were to assess plaque/calculus indices, irregularity index of the mandibular anterior teeth and retainers' failure rate. Comparisons were conducted using Mann-Whitney U test or chi-square test. Statistical significance was predetermined at the p≤ 0.05 level for all tests., Results: Complete data were collected for 46 patients (round multi-strand wire retainer group, n=24 patients; rectangular Ortho-Flex-Tech™ retainer group, n=22 patients). No significant differences were found in the gingival health parameters between the two groups (p>0.05). Ortho-Flex-Tech™ retainers maintained the alignment of mandibular anterior teeth more than multi-strand retainer (p<0.05). No significant difference was found in the failure rate between the two groups (p>0.05)., Conclusions: Gingival health parameters and failure rate were not different in both groups. However, Ortho-Flex-Tech™ retainers were more efficient to retain the mandibular incisors than the multi-strand retainers; nevertheless, the difference was not clinically significant.

Introduction: Mandibular micrognathism (MM) is an underdeveloped mandible resulting from complex interactions between genetic and environmental factors. Prior research focused mainly on the genetic determinants of mandibular retrognathism, not necessarily reflecting micrognathism, thus supporting the need to study MM. This study aimed to explore the inheritance pattern and identify the candidate genes involved in the development and familial transmission of MM., Methods: Diagnosing probands with MM was based on clinical and lateral cephalometric data. The pedigrees were drawn for 11 identified families, 5 of whom accepted to undergo detailed data and biospecimen collection. These families included 15 MM and 13 non-MM subjects over 2-3 generations. The procedure involved the withdrawal of 5 mL of blood. Genomic DNA was isolated from blood cells to investigate protein-coding regions via whole exome sequencing. Standardized filtering steps were employed, and candidate genes were identified., Results: Most of the pedigrees suggested a Mendelian inheritance pattern and segregated in an autosomal-dominant manner. One of the families, which also underwent biospecimen, displayed an X-linked inheritance pattern of the trait. Genetic screening disclosed 8 potentially novel genes (GLUD2, ADGRG4, ARSH, TGIF1, FGFR3, ZNF181, INTS7, and WNT6). None of the recognized exonic regions were previously reported., Conclusions: Eight novel genes were identified in association with MM in the largest number of families reported to date. The genes were X-linked in 1 family, a finding previously not observed in mandibular genetics., (Copyright © 2022 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Background: There have been reports of unique dental morphological features amongst Latin American and Hispanic populations, and this might invalidate the use of current orthodontic diagnostic tools within this population. There are no tooth size/tooth ratio normative standards for the Hispanic population, despite overwhelming evidence about differences in tooth size between racial groups., Objective: This study aimed to determine whether there are significant differences in 3-D tooth shape between patients with Angle Class I, Class II, and Class III dental malocclusion in the Hispanic population., Methodology: Orthodontic study models representing Hispanic orthodontic patients with Angle Class I, II, and III dental malocclusions scanned using an intra-oral scanner. The scanned models were digitized and transferred to a geometric morphometric system. Tooth size shape were determined, quantified, and visualized using contemporary geometric morphometric computational tools using MorphoJ software. General Procrustes Analysis (GPA) and canonical variates analysis (CVA) used to delineate the features of shape that are unique to each group., Result: The study revealed differences in tooth shape between the different dental malocclusion groups on all twenty-eight teeth that were studied; the pattern of shape differences varied between the teeth and the dental malocclusions. The MANOVA test criteria, F approximations, and P-values show that shape in all the groups was significantly different < 0.05., Conclusion: This study revealed differences in tooth shape between the different dental malocclusions on all teeth, and the pattern of shape differences varied between the different dental malocclusions group., (© 2023. The Author(s).)

To investigate the pharyngeal airway volume in different anteroposterior skeletal malocclusions. This study was prepared according to the Cochrane criteria for creating a systematic review and meta-analysis and confirms the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. This search was conducted to answer the patient/population, intervention, comparison and outcomes (PICO) question: To evaluate (outcome) and compare (comparison) whether there is a difference in airway volume in patients (participants) with different skeletal malocclusions diagnosed using 3D data (intervention).The first two authors extracted the data from the included studies and assessed the risk of bias in the individual studies using the Newcastle-Ottawa scale. Meta-analysis was done using STATA version 16, which compared various three-dimensional pharyngeal airway parameters in skeletal Class II and skeletal Class III malocclusions with that of skeletal class I malocclusion. Out of 370 articles from the initial search, 17 articles were included in the systematic review. Out of 17 studies, 12 eligible studies were included in the quantitative synthesis. The nasopharynx, oropharynx, hypopharynx, and total airway volume were increased in skeletal Class I malocclusion compared to that of skeletal Class II malocclusion and decreased in comparison to skeletal Class III malocclusion. The moderate quality of evidence indicates the total airway volume, oropharynx, and hypopharynx are largest in skeletal Class III compared to Class I and Class II skeletal malocclusion., Competing Interests: None

Aim: The present investigation aims to find out the prevalence of ectopic canines among skeletal class I, II, and III malocclusions and to evaluate its variability among different genders and their growth patterns., Material and Methods: The study sample included orthopantomograms (OPGs), lateral skull views, and study models of 999 patients collected from departmental archives. Among the selected samples, 258 were males and 738 were females. They were divided into skeletal class I, II, and III malocclusions sagittally and hypodivergent, normodivergent, and hyperdivergent groups according to their angle formed between point A-Nasion - point B (ANB) and angle formed between the Sella-Nasion (SN) plane and Gonion (Go) - Gnathion (Gn) plane (SnGoGn) values respectively., Results: Of the 999 samples, 738 (73.9%) were female and 260 (25.8%) were male patients. When compared to men, females had a higher proportion of ectopic canines. An estimated 62.3% of skeletal class I, 29.1% of skeletal class II, and 8.6% of skeletal class III cases were found to have ectopic canines. An estimated 720 (72.1%) patients were found to have maxillary ectopic canines and out of the available sample, 474 patients have horizontal growth patterns, 335 have average growth patterns and 190 patients have vertical growth patterns. Labial impaction was the commonest (65.4%) followed by palatal (24.8%). Bilateral impaction was comparatively more (51.1%) than unilateral impaction (48.2%). Maxilla was more prevalent (72.1%) as compared to the mandible (16.3%) and for both the arches it was (11.6%). Ectopic canines were identified in a total of 62.3% of cases with skeletal class I, 29.1% of cases with skeletal class II, and 8.6% of cases with skeletal class III., Conclusion: The bilateral ectopic canine was mostly seen in skeletal class I and class III malocclusions, whereas, a unilateral presentation was mostly seen in skeletal class II malocclusions., Clinical Significance: Knowing the likelihood of a maxillary canine erupting ectopically will aid clinicians in starting with interceptive therapy since this condition necessitates complex orthodontic mechanics.

Introduction: This study aimed to identify the vertical radiographic changes in nongrowing patients after treatment of anterior open bites (AOBs) using mini-implant assisted intrusion and to provide a predictive model to quantify the achievable intrusion., Methods: This retrospective radiographic study evaluated the dentoskeletal changes in adults using orthodontic mini-implants in 53 treated patients with AOB. Radiographs before and after posterior intrusion were utilized to evaluate the associated changes. Conventional cephalometric analyses provided data for assessment. A paired t test was used to identify significant changes. A regression model (best subsets selection algorithm) was generated to quantify the relationship between mini-implant-assisted intrusion and the resultant change in overbite. A matched, untreated control sample was used for comparison., Results: One hundred percent of AOBs were corrected using mini-implant-assisted intrusion of the maxillary molars. The overbite increased by an average of 3.6 mm. The average amount of maxillary first molar intrusion was 2.67 mm. The mandibular first molar moved an average of 1.93 mm closer to the palatal plane because of an average clockwise mandibular rotation of 0.78°. The occlusal plane steepened by an average of 3.95°. If all other inputs are held constant, 1 mm of intrusion of the maxillary first molar results in a 0.86 mm increase in overbite., Conclusions: Mini-implant-assisted intrusion successfully treated AOB in adults with significant dentoalveolar but no significant skeletal changes. An average of 2.67 mm of intrusion of the maxillary first molars is achievable with this method showing that 1 mm of intrusion of the maxillary first molar increased overbite by 0.86 mm. Longer periods of intrusion resulted in greater amounts of bite closure., (Copyright © 2022 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Patients suffering from hemoglobinopathies may suffer from pathogic dental and orofacial features. This study aimed to assess the prevalence of malocclusion and the need for orthodontic treatment in patients with β-thalassemia major (BTM) and sickle cell disease (SCD). The study was conducted on 311 blood transfusion-dependent patients with BTM or SCD and 400 healthy individuals aged 10 to 16. The types of malocclusion were evaluated based on Angle's classification and Dewey's modification, and their oral habits were recorded using a questionnaire. The need for orthodontic treatment was assessed through the Dental Health Component of the Index of Orthodontic Treatment Need (IOTN), and the data were compared with normal participants. The Index of Orthodontic Treatment Need-Dental Health Component (IOTN-DHC) assessment showed that patients had a higher prevalence of objective need for treatment (IOTN grades 4 and 5) compared to healthy children. The prevalence of class II malocclusion was significantly higher in patients. Patients showed significantly less Angle's Class I malocclusion compared to normal participants. Oral habits were presented in 61%, 64.15% and 62.4% of normal participants, BTM and SCD patients, respectively. The higher prevalence of Angle's class II malocclusion and higher percentage of IOTN grade 4 and 5 among BTM and SCD patients reveal the importance of early orthodontic assessment and intervention in children with BMT and SDC., Competing Interests: The authors declare no conflict of interest., (©2023 The Author(s). Published by MRE Press.)

Objective: To verify the associations between sagittal and vertical skeletal discrepancies, changes in upper airways, and breathing pattern in children and adolescents with Angle Class III and Class III subdivision malocclusions., Methods: Eighty-five children and adolescents with a mean age of 9.5 ± 1.74 years were selected. Cephalometry assessed the sagittal relationship (AO-BO measurement), facial types (Ricketts VERT index), nasopharynx, and oropharynx. An otorhinolaryngologist analyzed the breathing pattern and upper airway obstruction during anamnesis, physical examination, anterior rhinoscopy, and nasofibroscopy. Medical records were also reviewed. For statistical analysis, ordinary one-way ANOVA, Kruskal-Wallis (Tukey's post-hoc), unpaired t-test, Pearson's correlation, chi-square, and Fisher's exact tests (p < 0.05) were used., Results: The nasopharyngeal cephalometric dimension and pharyngeal tonsil hypertrophy were associated, whereas the oropharyngeal cephalometric dimension and palatine tonsils hypertrophy were not. Sagittal discrepancies were associated with septum deviation, while facial type was associated with inferior turbinate and palatine tonsils hypertrophy. However, facial type was not associated with breathing pattern, septum deviation, and pharyngeal tonsils hypertrophy., Conclusions: Sagittal discrepancies and type of malocclusion were not associated with breathing pattern and changes in upper airways, except for the severity of septum deviation and Class III malocclusions, which were associated with large sagittal discrepancies. Although the facial types analyzed presented signs of airway obstruction, the highest prevalence of inferior turbinate and palatine tonsils hypertrophy were found in patients with dolichofacial type., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Introduction: Bonded spurs, fixed or removable palatal cribs have been used to treat anterior open bite (AOB) in growing children. Different conclusions have been brought out by different authors. This meta-analysis aimed to evaluate the effect of bonded spurs, fixed and removable palatal cribs in the early treatment of AOB., Methods: A comprehensive electronic search was carried out through PubMed, Embase (via Ovid), MEDLINE (via Ovid), Cochrane Central Register of Controlled Trials, and Web of Science up to May 1, 2022. This meta-analysis was performed in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. The work was carried out by 2 reviewers in duplicate and independently, including electronic searching, data extracting, risk of bias assessment, quality of evidence grading, heterogeneity and statistical power analysis, and eligibility evaluation of the retrieved articles., Results: Four studies out of 181 articles were recruited in the meta-analysis after applying the inclusion and exclusion criteria. The results showed that bonded lingual spurs and fixed palatal crib or spurs produced similar overbite changes (mean difference, -0.32; 95% confidence interval, -1.06 to 0.43; P = 0.41; I 2  = 27%; meta power = 0.099). Fixed palatal crib and removable palatal crib also exhibited comparable effects in correcting AOB (mean difference, -0.02; 95% confidence interval, -0.90 to 0.86; P = 0.96; I 2  = 0%; meta power = 0.2182). The quality of evidence about these 2 outcomes assessed with GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) was low., Conclusions: Bonded lingual spurs, fixed palatal crib or spurs, and removable palatal crib had similar effects in the early treatment of AOB. Because the number of included studies was limited and only the overbite changes before and after treatment were assessed, more clinical randomized controlled studies with longer follow-ups are needed to get more clinically significant advice., (Copyright © 2022. Published by Elsevier Inc.)

Background: This study aimed to explore the changes in hard tissue after applying invisible orthodontic-orthognathic treatment and the digital design, and to explore the accuracy of the treatment effect of maxillofacial tissue after invisible orthodontic treatment and orthognathic treatment., Methods: From September 2020 to January 2022, 25 patients with class III skeletal malocclusion and 7 patients with class II skeletal malocclusion, were treated with invisible orthodontic treatment and orthognathic combined treatment. Orthodontic treatment with preoperative invisible orthodontic treatment followed by orthodontic surgery. All patients had cephalometric lateral films after surgery to analyze orthognathic surgery's goals and surgical effects of orthognathic surgery and the digital design. Measure the angle of the sella-nasion-A point angle, angle of sella-nasion-B point, ANB angle, maxillary convex angle, mandibular plane (MP) angle, 1-SN angle, 1-MP angle, etc, and compare surgery outcome with digital design., Result: All patients were satisfied with the effect and no complications occurred. Angle of sella-nasion-A point, angle of sella-nasion-B point, ANB angle, maxillary convex angle, MP angle, 1-SN angle, and 1-MP angle had no significant difference between the postoperative effect and the purpose of digital design ( P >0.05), there was no apparent deviation between the upper and lower jaw and the chin ( P >0.05)., Conclusion: The combined invisible orthodontic treatment and orthognathic treatment are accurate and effective, and are worthy of promotion. It supplements traditional orthognathic therapy and is suitable for corresponding patients., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 by Mutaz B. Habal, MD.)

Orthognathic patients with skeletal class II malocclusion frequently suffer from myofascial pain (MP)., Purpose: This study aimed to evaluate the prevalence and associated factors of MP in these patients., Methods: This cross-sectional study was performed in adult patients with skeletal Class II malocclusion requiring orthognathic surgery. They were divided according to the presence or absence of MP. The predictor variables were craniofacial morphology, sex, temporomandibular disorders, chronic pain, depression, and polymorphisms of dopamine receptors DRD2 (rs6275 and rs6276) and ANKK1 (rs1800497) genes. Data were submitted to statistical analyses using the linear regression model and Poisson regression with a significance level of 0.05., Results: Sixty-five individuals were selected, of which 50 (76.92%) were females. A total of 21 (32.3%) patients had MP. Individuals with MP showed a decrease in the mandible gonial angle (p = 0.042) and an increased risk of having temporomandibular joint (TMJ) disc displacement (p = 0.003), TMJ pain (p = 0.030), chronic pain (p = 0.001), and severe depression (p = 0.015). Additionally, individuals carrying AA and AG genotypes in rs6275, and CC genotype in rs6276, were more likely to have MP (p < 0.05)., Conclusion: In this study, 32.3% of skeletal class II orthognathic patients had MP, which was associated with a decreased gonial angle, TMJ disc displacement, TMJ pain, chronic pain, depression, and polymorphisms in the DRD2 gene., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Mandibular Advancement Devices (MAD's) are oral appliances commonly used in treatment of Obstructive Sleep Apnea (OSA). OSA severity and certain other factors, such as BMI and neck circumference, correlate with MAD therapy success. So far, the predictive value of dental parameters, such as dental profile, molar-classification, overjet, overbite, maximal retrusion, maximal protrusion and protrusive range, has not been fully investigated., Objectives: We aimed to investigate whether dental parameters influence OSA severity and MAD therapy outcome and could therefore be helpful in phenotyping OSA patients. Furthermore, we studied the predictive power of dental parameters for OSA severity and successful MAD therapy. We hypothesise that specific dental parameters correlate with more severe OSA and with more successful MAD treatment., Methods: We performed a cohort study, including OSA patients diagnosed by polysomnography (PSG). Dental parameters were collected. Objective treatment outcome was collected by performing a PSG with MAD after three months of therapy. Differences between OSA severity groups and MAD treatment outcomes were analysed and dental parameters were correlated between groups., Results: The relation between dental parameters and OSA severity was analysed in 143 patients, fifty patients had a PSG with MAD in situ after a 3-month therapy. The median baseline Apnea Hypopnea Index (AHI) significantly reduced from 17.6 (8.7-29.3) to 11.1 (5.5-17.5). Overbite and maximal retrusion differed significantly between mild, moderate and severe OSA. Other dental parameters did not differ significantly between the groups, nor correlated with OSA severity or MAD treatment outcome., Conclusion: In this study, no correlation between dental parameters and OSA severity or MAD treatment outcomes was found. Therefore, screening patients for OSA and MAD treatment outcome based on dental parameters is currently not possible., (© 2022 The Authors. Journal of Oral Rehabilitation published by John Wiley & Sons Ltd.)

Introduction: An increase in life expectancy was observed in the past years. Consequently, the knowledge of the maturational changes in the occlusion is highly important to guide clinicians during treatment planning., Objective: In this article, the occlusal and facial aging changes occurred during almost 50 years of follow-up are described. A normal occlusion sample from Bauru Dental School, University of São Paulo, Brazil, was evaluated at 13 (T1), 17 (T2) and 60 (T3) years of age. The maturational changes observed in digital dental models and cephalometric radiographs were presented. A revision of the aging process, under the gerontology and psychology perspectives, was also explored., Discussion: Maturational changes in non-treated individuals were very delicate. Mandibular crowding, decrease in the overbite, changes in the maxillary second molar position, increase in the clinical crown length, dental wear and discoloration were observed., Conclusion: Compared to the remarkable facial and skin changes during aging, the occlusion seems to be the most stable feature of the face during the aging process., Final Considerations: An adequate oral care throughout lifetime makes the smile the best memory of youth at mature ages.

Background: Condyle-fossa relationships in adolescents with skeletal Class III malocclusion remain unclear. Therefore, this study used cone-beam computed tomography (CBCT) to evaluate the position and morphology of the temporomandibular joint (TMJ) in adolescents with skeletal Class III malocclusion., Methods: In this cross-sectional retrospective study, CBCT images from 90 adolescents with skeletal Class III malocclusion and 30 controls were analysed. Adolescents with skeletal Class III malocclusion were divided into different groups based on (1) sex (male and female), (2) sides (right and left), (3) age (early, middle, and late adolescence), and (4) vertical skeletal patterns (hyperdivergent, normodivergent, and hypodivergent). Morphology of the condyle and fossa as well as condylar position, was compared among groups. Data were collected and submitted for statistical analysis. This study adheres to STROBE guidelines., Results: Regarding the intergroup comparisons, there were significant differences in TMJ position and morphology between the skeletal Class III malocclusion with different vertical skeletal patterns and control groups (P < 0.05). Within groups, condyle-fossa relationships differed significantly according to sex, age, and vertical skeletal patterns (P < 0.05); however, the mean values were not statistically different between left and right sides in adolescents with skeletal Class III malocclusion., Conclusions: Our findings can be used clinically and radiographically to evaluate the condyle and glenoid fossa features in adolescents with skeletal Class III malocclusion, providing a basis for better TMD diagnosis and orthodontic treatment., (© 2023. The Author(s).)

Aims: To assess palatal volume, surface area and linear dimensions across sagittal and vertical components of malocclusion., Methods: Pre-treatment cephalographs and dental casts of 178 non-growing patients (88 males, 90 females, age 25.81 ± 8.23 years) were used for classification in sagittal malocclusion groups: Class I (n = 48), Class II division 1 (n = 42), Class II division 2 (n = 40) and Class III (n = 48); and in vertical divergence groups based on the MP/SN angle: hypodivergent (n = 35), normodivergent (n = 95) and hyperdivergent (n = 48). Dental casts were scanned and palatal measurements recorded: palatal width, depth and interdental distances; palatal surface area (PSA, mm 2 ) and volume (PV, mm 3 ). A 3-way ANOVA was used to compare palatal dimensions across groups. Pearson product-moment correlations were employed to assess associations among variables., Results: PSA and PV (in both sex groups) were not statistically significantly different across sagittal malocclusions and vertical patterns. Significant differences were depicted more among the vertical divergence groups than sagittal groups. Correlations between PSA and PV and palatal dimensions were low to moderate. Predictability of PSA and PV ranged between 15 and 18%., Conclusion: The finding of similar palatal volume and surface area, on average, across malocclusions possibly underscores the limitations of environmental influences within the inherited orofacial phenotype. The vertical facial pattern seems to be more interactive with palatal dimensions than sagittal relations. Studies of palatal changes following orthodontic and orthognathic treatments are warranted., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)