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13 pages, 341 KiB

Open AccessArticle

User Experience, Satisfaction, and Complications of Direct-to-Consumer Orthodontics in Spain: A Cross-Sectional Study

by Milagros Adobes Martin, Adriana Pérez Márquez, Simonetta Meuli, Adrian Curtó Aguilera, Mario Dioguardi, Riccardo Aiuto and Daniele Garcovich

J. Clin. Med. 2025, 14(7), 2382; https://doi.org/10.3390/jcm14072382 - 30 Mar 2025

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Abstract

Background/Objectives: Direct-to-Consumer Orthodontics (DTCO) has gained popularity through social media, offering clear aligner treatments without in-person supervision. However, there is limited research on the related user experiences, satisfaction, and complications, particularly in Spain. This study aimed to evaluate user experiences, satisfaction levels, and [...] Read more.

Background/Objectives: Direct-to-Consumer Orthodontics (DTCO) has gained popularity through social media, offering clear aligner treatments without in-person supervision. However, there is limited research on the related user experiences, satisfaction, and complications, particularly in Spain. This study aimed to evaluate user experiences, satisfaction levels, and complications associated with DTCO in a sample of Spanish consumers. Additionally, differences among major DTCO providers were analyzed. Methods: A cross-sectional online survey was conducted over one year. This questionnaire, adapted from previous studies and reviewed by certified orthodontists, assessed user awareness, reasons for treatment selection, communication with providers, discomfort, complications, and satisfaction. A total of 101 valid responses were analyzed using statistical means. Results: The majority of respondents reported that their expectations were not met, and they would not recommend DTCO. Cost was the primary motivation for treatment selection, followed by convenience. Many users experienced complications, leading to dental consultations. While overall satisfaction levels did not significantly differ among providers, variations were observed in discomfort levels, in-person care availability, and the need for additional consultations. Conclusions: DTCO offers affordability and convenience but raises concerns regarding treatment quality and supervision. In most cases, users’ expectations were not met, highlighting the need for greater patient education and regulatory oversight. Full article

(This article belongs to the Special Issue Orthodontics: Current Advances and Future Options)

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12 pages, 3391 KiB

Open AccessArticle

The Influence of Anteroposterior Head Inclination on the Perceived Consonance of the Smile Arc and Lower Lip Curvature on Photographs: A Cross-Sectional Study

by Amir Reza Khadem, Matteo Togninalli, Gregory S. Antonarakis and Cristina Vento

J. Clin. Med. 2025, 14(5), 1658; https://doi.org/10.3390/jcm14051658 - 28 Feb 2025

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Abstract

Objectives: To determine the extent to which anteroposterior head inclination influences smile arc curvature assessment on frontal photographs. Materials and Methods: Sixty-three young adults participated in this study. Each had five standardized frontal-view photographs captured with posed smiles at five anteroposterior head inclinations [...] Read more.

Objectives: To determine the extent to which anteroposterior head inclination influences smile arc curvature assessment on frontal photographs. Materials and Methods: Sixty-three young adults participated in this study. Each had five standardized frontal-view photographs captured with posed smiles at five anteroposterior head inclinations (−20°, −10°, 0°, +10°, +20°) using a cervical range of motion device. Two curves were traced per photograph: one following the shape of the lower lip and the other the incisal edge of the maxillary anterior teeth from canine to canine (smile line). These curvatures were approximated by quadratic function and compared for concordance based on the maximum curvature of the obtained functions. A score was calculated, with 0 denoting a consonant smile (perfect concordance) and 2 a non-consonant smile. Results: Among the sixty-three participants, fifty-nine were included in the analysis after excluding those with insufficient tooth exposure in the photographs for the smile line assessment. The analysis revealed that the perceived smile line was more consonant (concordant with lower lip curvature) with a −20° head anteroposterior inclination (score: 0.146), and the least consonant with +20° anteroposterior inclination (score: 1.326), with statistically significant differences (p < 0.05). Conclusions: The smile arc curvature assessment on frontal photographs may be influenced by the anteroposterior inclination of the head on frontal photographs. However, due to the two-dimensional nature of this study, further investigations incorporating three-dimensional imaging are recommended. Full article

(This article belongs to the Special Issue Orthodontics: Current Advances and Future Options)

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10 pages, 1645 KiB

Open AccessArticle

The Maxillomandibular Sagittal Assessment: The ABwise Appraisal and Its Correlation with ANB Angle

by Elisa Boccalari, Ornella Rossi, Benedetta Baldini, Cinzia Tripicchio, Marco Serafin and Alberto Caprioglio

J. Clin. Med. 2025, 14(4), 1379; https://doi.org/10.3390/jcm14041379 - 19 Feb 2025

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Abstract

The ANB angle, the cephalometric parameter of choice for assessing the anteroposterior relationship between the maxilla and mandible, is subject to several limitations, prompting the investigation of alternative parameters. Objective: This study aimed to investigate the ABwise measurement as an alternative to the [...] Read more.

The ANB angle, the cephalometric parameter of choice for assessing the anteroposterior relationship between the maxilla and mandible, is subject to several limitations, prompting the investigation of alternative parameters. Objective: This study aimed to investigate the ABwise measurement as an alternative to the ANB angle for evaluating maxillomandibular relationships in orthodontics, particularly addressing the impact of skeletal discrepancies on conventional methods. Methods: A retrospective analysis was performed on a CBCT dataset of patients attending the University of Milan’s Department of Orthodontics and Maxillofacial Surgery, selected based on high-quality imaging, a full-cranium field of view, and a slice thickness between 150 and 300 μm. Eight craniofacial landmarks were annotated using the 3D Slicer software to calculate the ANB values and the new ABwise measurement. Statistical analyses included Spearman’s correlation (ρ), linear regression, and inter-rater agreement (Cohen’s κ score), with data classified into skeletal Classes I, II, and III based on defined thresholds. Results: 354 CBCT were selected and analyzed (mean age: 18.6 years). ABwise showed a strong correlation with the ANB angle (ρ = 0.805) and new normative ranges for ABwise were established: Class I (−1.4 ± 2.3 mm), Class II (>0.9 mm), and Class III (<−3.7 mm). Moderate agreement was observed between the ABwise and ANB classifications (κ = 0.527). ABwise effectively addressed limitations associated with divergence and vertical discrepancies, providing a more reliable assessment of skeletal sagittal relationships. Conclusions: ABwise presents a viable alternative to the ANB angle for three-dimensional cephalometric analysis, offering improved accuracy and alignment with radioprotection principles by reducing the CBCT field of view needed for its measurement. Further research is required in order to validate these findings across diverse populations and clinical scenarios. Full article

(This article belongs to the Special Issue Orthodontics: Current Advances and Future Options)

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13 pages, 3236 KiB

Open AccessArticle

Airway Analysis and Morphometric Assessment of Dental Arches in Obstructive Sleep Apnea Patients

by Domenico Ciavarella, Donatella Ferrara, Giusi Spinoso, Paolo Cattaneo, Chiara Leo, Lucio Lo Russo, Giuseppe Burlon, Carlotta Burlon, Fariba Esperouz, Michele Laurenziello, Michele Tepedino and Mauro Lorusso

J. Clin. Med. 2025, 14(2), 296; https://doi.org/10.3390/jcm14020296 - 7 Jan 2025

Cited by 1 | Viewed by 1065

Abstract

Background: Obstructive sleep apnea is a sleep-related breathing disorder associated with craniofacial morphology and dental arches. The aim of this study was to evaluate the correlation between obstructive sleep apnea and the morphometry of dental arches and upper airways. Methods: Forty [...] Read more.

Background: Obstructive sleep apnea is a sleep-related breathing disorder associated with craniofacial morphology and dental arches. The aim of this study was to evaluate the correlation between obstructive sleep apnea and the morphometry of dental arches and upper airways. Methods: Forty patients were enrolled in the study, and the polysomnographic parameters evaluated were the apnea hypopnea index (AHI) and the oxygen desaturation index (ODI). Dental measurements taken from the 3D models included anterior arch widths, posterior arch widths, maxillary and mandibular arch lengths, and palatal surface area. A cone beam computed tomography (CBCT) evaluation was also performed. Results: In patients with moderate OSA, posterior maxillary width was significantly correlated with both minimal airway area (rho = 0.65, p < 0.01) and its transverse diameter (rho = 0.68, p < 0.01). Similarly, in patients with severe OSA, posterior maxillary width showed a significant correlation with total airway volume (rho = 1, p < 0.01), minimal airway area (rho = 1, p < 0.01), and its transverse diameter (rho = 1, p < 0.01). Conclusions: Craniofacial morphology and malocclusion can contribute to obstructive sleep apnea syndrome. Full article

(This article belongs to the Special Issue Orthodontics: Current Advances and Future Options)

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11 pages, 1667 KiB

Open AccessArticle

An Evaluation of the Estimated Aligners Needed to Correct Malocclusion Traits Using Invisalign ClinCheck™ Pro Software: A Retrospective Study

by Ileana Rosa Rincon-Gregor, Cielo Ivette Bautista-Rojas, Elsy Abigail Trejo-Aké, Iván Daniel Zúñiga-Herrera and José Rubén Herrera-Atoche

J. Clin. Med. 2024, 13(21), 6552; https://doi.org/10.3390/jcm13216552 - 31 Oct 2024

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Abstract

Background: This study evaluated the number of aligners that Invisalign ClinCheck™ Pro Software estimates for correcting different malocclusion traits. Methods: This retrospective study included 157 non-extraction patients over the age of 12 years old with easy to mild malocclusions who were treated with [...] Read more.

Background: This study evaluated the number of aligners that Invisalign ClinCheck™ Pro Software estimates for correcting different malocclusion traits. Methods: This retrospective study included 157 non-extraction patients over the age of 12 years old with easy to mild malocclusions who were treated with Invisalign aligners. The Index of Complexity, Outcome, and Need (ICON) was used to evaluate the malocclusion complexity level. The number of aligners (upper, lower, and total) required to correct the malocclusion was compared based on sex, ICON level, molar and canine class, occlusal asymmetry, overbite, overjet, crowding, incisor inclination, and Bolton discrepancy. A Mann–Whitney U test (for comparisons between two groups) or a Kruskal–Wallis test (for comparisons between three or more groups) (p < 0.05) was used to evaluate differences in the number of aligners across variable categories. Results: ICON, molar class, overbite, and overjet presented significant differences (p < 0.05) in the number of aligners (upper, lower, and total) required to correct a malocclusion. Canine class and lower dental crowding showed significant differences in the lower and total number of aligners (p < 0.05). Conclusions: The number of aligners increases when the malocclusion presents any of the following elements: the absence of molar or canine class I, an altered overjet or overbite, severe lower crowding, or a higher complexity level. The clinician should consider these malocclusion traits when estimating the number of aligners needed for correction. Full article

(This article belongs to the Special Issue Orthodontics: Current Advances and Future Options)

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12 pages, 1163 KiB

Open AccessArticle

Cone-Beam Computed Tomography (CBCT) Analysis of Mandibular Condyles’ Diameters in Patient with Juvenile Idiopathic Arthritis and Temporomandibular Joint Affection: A Cross-Sectional Investigation

by Margherita Donelli, Valentina Lanteri, Alessandro Ugolini, Alessandro Bruni, Paolo Cressoni, Andrea Abate and Cinzia Maspero

J. Clin. Med. 2024, 13(17), 5104; https://doi.org/10.3390/jcm13175104 - 28 Aug 2024

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Abstract

Objectives: The aim of this study was to evaluate through analysis using CBCT the transverse and axial diameters of the mandibular condyles in subjects affected by juvenile idiopathic arthritis (JIA) and compare them with those of healthy subjects. Methods: The study was conducted [...] Read more.

Objectives: The aim of this study was to evaluate through analysis using CBCT the transverse and axial diameters of the mandibular condyles in subjects affected by juvenile idiopathic arthritis (JIA) and compare them with those of healthy subjects. Methods: The study was conducted on CBCT scans from the digital archive of the Department of Biomedical Surgical and Dental Sciences, University of Milan, including patients with JIA and using healthy subjects as controls. Inclusion criteria: aged between 7 and 25 years old at the time of the CBCT examination; Caucasian ethnicity; diagnosis of JIA according to the International League of Associations for Rheumatology (ILAR) criteria documented in patients’ records; TMJ involvement; good quality CBCTs covering our region of interest (ROI), from the glabella to the mandibular inferior border; no previous orthodontic/orthopedic treatment; no history of craniofacial trauma or congenital birth defects involving the craniofacial area. Each CBCT scan underwent examination using 3Diagnosys^® software. Since data were normally distributed, parametric tests were used for analysis. The sample was divided into three groups: (1) bilateral JIA subjects, (2) unilateral JIA subjects, and (3) healthy controls. Results: We found a statistically significant reduction (p < 0.0001) in the transverse diameter (TR-Diam) of the affected condyles by an average of 1.7 mm, while the axial diameter (AX-Diam) again showed a slight reduction, on average by 0.1 mm, with a non-statistically significant value. Another comparison was made between the unaffected condyles of patients with unilateral JIA and the healthy condyles of the control group. The unilateral unaffected condyles were found to be slightly smaller than those of healthy patients, but without statistically significant differences. We found that in both JIA males and females, the condylar growth tends to stop earlier than the healthy ones. Conclusions: The transverse diameter was found to be more affected than the axial one, causing typical bone resorption and condylar shape. Moreover, we showed that the pathology, in the case of unilateral JIA, does not compromise only the affected condyles; the corresponding condyle that seems to be healthy is actually partially compromised. In addition, we observed that the growth of affected condyles of JIA subjects tends to stop earlier than the condyles of the healthy controls. Full article

(This article belongs to the Special Issue Orthodontics: Current Advances and Future Options)

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21 pages, 1539 KiB

Open AccessSystematic Review

Head and Cervical Posture in Sagittal Skeletal Malocclusions: Insights from a Systematic Review

by Gianna Dipalma, Alessio Danilo Inchingolo, Carmela Pezzolla, Roberta Sardano, Irma Trilli, Daniela Di Venere, Massimo Corsalini, Francesco Inchingolo, Marco Severino, Andrea Palermo and Angelo Michele Inchingolo

J. Clin. Med. 2025, 14(8), 2626; https://doi.org/10.3390/jcm14082626 - 11 Apr 2025

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Abstract

Background: This systematic review aims to evaluate the relationship between craniocervical posture and sagittal skeletal malocclusions, focusing on cervical curvature, head posture, and the influence of skeletal classification on craniofacial development. Methods: A comprehensive electronic search was conducted across PubMed, Scopus, and Web [...] Read more.

Background: This systematic review aims to evaluate the relationship between craniocervical posture and sagittal skeletal malocclusions, focusing on cervical curvature, head posture, and the influence of skeletal classification on craniofacial development. Methods: A comprehensive electronic search was conducted across PubMed, Scopus, and Web of Science for studies published between January 2015 and January 2025. Studies meeting the PICOS criteria, which assessed craniocervical posture in individuals with skeletal Class I, II, or III malocclusions, were included. A total of 12 studies were reviewed and analyzed for relevant data. Results: Significant correlations were identified between sagittal skeletal malocclusions and craniocervical posture, particularly cervical curvature. Class II malocclusion was associated with increased cervical curvature and forward head posture, whereas Class III malocclusion was linked to straighter cervical columns and a more posterior head position. Variations in cervical vertebral morphology were also observed, especially in relation to head posture and craniofacial structure. However, considerable heterogeneity was noted among studies regarding sample populations, measurement techniques, and classification criteria. Conclusions: This review highlights a strong interrelationship between craniocervical posture and sagittal skeletal classification, with potential clinical implications for orthodontic diagnosis and treatment planning. Further longitudinal studies are needed to establish causal relationships and improve orthodontic management strategies. Full article

(This article belongs to the Special Issue Orthodontics: Current Advances and Future Options)

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16 pages, 6188 KiB

Open AccessCase Report

Orthodontic Treatment of a Transmigrating Impacted Lower Canine Using a Digitally Designed and 3D-Printed Lingual Appliance Combined with Corticotomy and Laser Therapy—A Case Report

by Anna Ewa Kuc, Jacek Kotuła, Maria Kulgawczyk, Krzysztof Kotuła, Zuzanna Grzech-Leśniak, Aneta Zalewska, Justyna Kulikowska-Kulesza, Beata Kawala, Joanna Lis and Michał Sarul

J. Clin. Med. 2025, 14(4), 1368; https://doi.org/10.3390/jcm14041368 - 19 Feb 2025

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Abstract

Background: Canines play a vital functional and aesthetic role in human dentition, yet impacted canines, particularly in the mandible, are rare and can lead to functional disorders, such as the absence of canine guidance, while negatively affecting a patient’s self-esteem. Transmigration of mandibular [...] Read more.

Background: Canines play a vital functional and aesthetic role in human dentition, yet impacted canines, particularly in the mandible, are rare and can lead to functional disorders, such as the absence of canine guidance, while negatively affecting a patient’s self-esteem. Transmigration of mandibular canines adds complexity to treatment. One method to reduce the treatment time, especially for impacted teeth, is corticotomy-assisted orthodontic therapy (CAOT). Methods: A 13-year-old patient presented with a horizontally impacted lower right canine, positioned below the roots of the lower incisors, showing transmigration. A digitally designed and 3D-printed lingual appliance was attached to the lower molars with hooks on the lingual side, enabling the application of multi-directional orthodontic forces. CAOT was performed using an Er:YAG laser (LightWalker, Fotona, Ljubljana, Slovenia) at 200 mJ, 12 Hz, 2.4 W, with a pulse duration of 100 µs, and an MSP H14 conical tip (0.6 mm spot diameter). Photobiomodulation (PBM) with a 635 nm diode laser (Lasotronix, Smart ProM, Piaseczno, Poland) was applied at 10 J per point (20 J/cm²) for 100 s per point, with a total energy of 20 J per session to reduce the risk of root resorption, manage pain, and accelerate healing as the tooth was moved into the alveolar ridge. Results: The treatment duration was two and a half years. The lingual appliance with hooks allowed precise traction of the canine, aided by exposure from the lingual side and the attachment of a hook. Gentle forces applied via orthodontic thread gradually moved the canine beneath the oral mucosa. Mid-treatment cone beam computed tomography (CBCT) scans confirmed the absence of root resorption of the lower incisors. A corticotomy, enhanced by laser therapy, was performed before moving the canine into the alveolar ridge. The canine was successfully rotated 180° and positioned without any signs of resorption in the canine or adjacent teeth. Conclusions: The use of a digitally designed and 3D-printed lingual appliance with hooks allowed the precise control of the traction of impacted teeth. When combined with corticotomy and laser therapy, it minimised root resorption risks, reduced pain, accelerated healing, and improved the overall success of the orthodontic treatment. Full article

(This article belongs to the Special Issue Orthodontics: Current Advances and Future Options)

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26 pages, 1666 KiB

Open AccessSystematic Review

Orthopedic Devices for Skeletal Class III Malocclusion Treatment in Growing Patients: A Comparative Effectiveness Systematic Review

by Angelo Michele Inchingolo, Alessio Danilo Inchingolo, Irma Trilli, Laura Ferrante, Angela Di Noia, Elisabetta de Ruvo, Andrea Palermo, Francesco Inchingolo and Gianna Dipalma

J. Clin. Med. 2024, 13(23), 7141; https://doi.org/10.3390/jcm13237141 - 25 Nov 2024

Cited by 4 | Viewed by 1824

Abstract

Background/Objectives: Skeletal Class III malocclusion (Cl III) presents a significant orthodontic challenge, particularly in growing patients, requiring interceptive treatment to achieve effective functional and aesthetic correction. This review aims to compare various orthopedic devices and therapeutic protocols used in Cl III correction, identifying [...] Read more.

Background/Objectives: Skeletal Class III malocclusion (Cl III) presents a significant orthodontic challenge, particularly in growing patients, requiring interceptive treatment to achieve effective functional and aesthetic correction. This review aims to compare various orthopedic devices and therapeutic protocols used in Cl III correction, identifying the most effective options in an interceptive context. Methods: We searched the PubMed, Scopus, and Web of Science databases for studies published between 1 January 2003, and 19 July 2023. Inclusion criteria included English language, human studies, open access, and studies addressing Cl III correction with interceptive orthopedic devices. Results: Exclusions included in vitro, animal, off-topic studies, reviews, meta-analyses, and articles in languages other than English. After removing duplicates, 30 articles were selected from a total of 1193 results. Conclusions: The application of orthopedic devices in growing patients can lead to rapid improvement of Cl III malocclusion, although each device has specific effects on the surrounding skeletal structure. Full article

(This article belongs to the Special Issue Orthodontics: Current Advances and Future Options)

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14 pages, 478 KiB

Open AccessSystematic Review

The Effect of Corticotomy-Assisted Orthodontic Therapy (CAOT) or Periodontally Accelerated Osteogenic Orthodontics (PAOO) on Bone Remodeling and the Health of Periodontium: A Systematic Review of Systematic Reviews

by Anna Ewa Kuc, Maria Kulgawczyk, Magdalena Ewa Sulewska, Natalia Kuc, Beata Kawala, Joanna Lis, Michał Sarul and Jacek Kotuła

J. Clin. Med. 2024, 13(19), 5726; https://doi.org/10.3390/jcm13195726 - 26 Sep 2024

Cited by 5 | Viewed by 2085

Abstract

Background: Orthodontic treatment involves moving teeth within the alveolar ridge. Bone remodeling is associated with the activity of osteoblasts and osteoclasts. Procedures such as corticotomy-assisted orthodontic therapy (CAOT) or periodontally accelerated osteogenic orthodontics (PAOO) are intended to reduce bone density and negative stress [...] Read more.

Background: Orthodontic treatment involves moving teeth within the alveolar ridge. Bone remodeling is associated with the activity of osteoblasts and osteoclasts. Procedures such as corticotomy-assisted orthodontic therapy (CAOT) or periodontally accelerated osteogenic orthodontics (PAOO) are intended to reduce bone density and negative stress on the grip side and therefore limit bone resorption during orthodontic movement or add bone substitute material so that the tooth does not cross the vestibular plate. Methods: The study was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The study design was defined in the PICO format—Population (P): patients with full permanent dentition, both adolescents and adults; Intervention (I): orthodontic treatment with fixed appliances using additional supportive treatments such as CAOT or PAOO; Comparison (C): assessment of the impact of additional treatments during orthodontic treatment on the remodeling of the alveolar bone and the condition of the periodontium; Result (O): statistically significant/non-significant differences in the condition of the alveolar bone before and after orthodontic treatment. Search filters include the time of publication of the article, systematic reviews from the last five years, and publications that appeared in English. The information provided in the abstracts of systematic reviews that describe the effects of additional procedures during orthodontic treatment such as CAOT or PAOO on the health of periodontium was analyzed. Articles unrelated to the subject of the planned study and those in which tooth movement acceleration was analyzed were excluded. Results: Eight articles were selected in which a total number of 835 subjects took part. The changes in bone density and effects on periodontium were different after CAOT and PAOO. Conclusions: The validity of CAOT and PAOO procedures remains controversial. Better results are obtained when combined with tissue augmentation or thickening of the gingival phenotype rather than as stand-alone procedures, as their uses to protect periodontal tissues are limited. Full article

(This article belongs to the Special Issue Orthodontics: Current Advances and Future Options)

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