Search Results (264)

Background and Clinical Significance: Severe skeletal Class II malocclusion associated with periodontal compromise and posterior edentulism requires a carefully sequenced interdisciplinary treatment approach integrating orthodontic, surgical, periodontal, and prosthetic rehabilitation. Case Presentation: This case report describes the comprehensive interdisciplinary management of a 21-year-old female patient presenting with skeletal Class II malocclusion, severe mandibular retrognathia, vertical maxillary excess, labial incompetence, temporomandibular joint (TMJ) dysfunction and periodontal deficiencies. The treatment sequence involved occlusal splint therapy, pre-surgical orthodontic decompensation, bimaxillary orthognathic surgery using a segmental Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO), postoperative orthodontic refinement with aligners, periodontal plastic surgery using the Zucchelli technique and guided bone regeneration (GBR) with implant placement in the posterior mandible. At the four-year follow-up, the patient demonstrated complete root coverage, stable skeletal correction, and satisfactory implant integration, with maintenance of functional and aesthetic outcomes over time. Conclusions: This report highlights the importance of precise preoperative planning and the synergy between orthodontics, orthognathic surgery and periodontics in achieving optimal functional and aesthetic results. Full article

Clear aligner therapy has become increasingly widespread in contemporary orthodontics, relying on composite resin attachments to enhance force transmission and improve the predictability of tooth movement. The physicochemical and mechanical properties of these biomaterials play a crucial role in attachment durability, dimensional stability, and esthetic performance during treatment. This systematic review aimed to evaluate how different composite resin types influence the mechanical, optical, and functional performances of orthodontic attachments used in clear aligner therapy. A systematic literature search was conducted in the PubMed, Scopus, and Cochrane databases for studies published between 2015 and 2025, following PRISMA guidelines. In vitro studies and clinical trials evaluating composite resins used for attachment fabrication were included. Fifteen studies met the eligibility criteria, including eleven laboratory investigations and four clinical studies. The evaluated outcomes comprised shear bond strength, wear resistance, surface roughness, microhardness, color stability, and accuracy of attachment reproduction. Overall, all evaluated composite resins demonstrated shear bond strength values within clinically acceptable ranges. However, significant differences were observed in the material performances depending on the resin composition and viscosity. Nanohybrid and high-viscosity composite resins were generally associated with improved mechanical resistance, reduced wear, and greater dimensional stability, although SBS outcomes should be interpreted in light of the bonding protocols used. In contrast, flowable composite resins showed improved handling and adaptation to attachment molds but presented higher susceptibility to surface degradation and discoloration. The findings suggest that the composition and properties of composite resins significantly influence the mechanical and optical behavior of orthodontic attachments. Optimizing material selection according to biomechanical demands and esthetic requirements may improve attachment longevity and treatment predictability in clear aligner therapy. Clinicians should prioritize nanohybrid or high-viscosity composite resins for high-load attachments and use flowable composite resins materials when adaptation and esthetics are critical. Full article

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

Background/Objectives: Orofacial myofunctional therapy (OMT) is a system of targeted neuromuscular exercises and behavioral retraining intended to optimize tongue, lip, jaw, and airway function during rest, breathing, swallowing, and sleep. Historically associated with tongue thrust and abnormal swallowing, OMT is now applied across an expanding range of clinical contexts, including sleep-disordered breathing (SDB), tongue-tie rehabilitation, orthodontic stability, and perioperative functional recovery. As its use has broadened, persistent questions have followed: what is myofunctional therapy, where did it originate, and how did a set of oral exercises evolve into an intervention increasingly integrated with airway health, sleep medicine, and surgical care? Methods: This article presents a narrative historical review with a perspective component, synthesizing foundational literature, interdisciplinary contributions, and selected contemporary evidence to examine the evolution of OMT from ancient functional practices to modern clinical science. It is written to trace recurring clinical observations, shifts in educational frameworks, and key inflection points that shaped how OMT has been taught and applied over time. Results: OMT did not emerge from randomized controlled trials or standardized protocols. It arose from repeated clinical encounters with patients with atypical craniofacial development, relapse of structural correction, persistent mouth breathing, and/or unresolved swallowing and speech dysfunction despite technically successful treatment. These patterns suggested that anatomy alone could not account for outcome variability. Over time, clinical attention expanded beyond isolated tongue function to include breathing patterns, posture, neuromuscular tone, and airway behavior. In the past two decades, controlled trials, cohort studies, and systematic reviews have supported selected applications of OMT, particularly in SDB and adjunctive airway care, while also revealing ongoing challenges related to training variability, terminology, scope of practice, and standardization. Conclusions: OMT has historically been described as a system of targeted neuromuscular and behavioral interventions aimed at modifying orofacial rest posture and function. Over time, the field has expanded beyond localized muscle retraining toward a broader functional framework that integrates airway physiology, craniofacial growth, sleep, and interdisciplinary rehabilitation. Full article

Background and Clinical Significance: Dental trauma presents a considerable challenge for clinicians due to the diverse and complex effects on teeth. Effective management often requires the collaboration of multiple specialists, including endodontists and orthodontists. Case Presentation: This case report presents the interdisciplinary management of a complex dental trauma case involving three permanent maxillary anterior teeth. Unlike most reports of dental trauma, this case includes complete pre-trauma diagnostic records, providing valuable baseline information for treatment planning and outcome assessment. A 15-year-old female patient was examined in the orthodontic clinic, with comprehensive diagnostic records being obtained at the initial visit. Before the commencement of active orthodontic therapy, the patient experienced an extraoral traumatic incident. Clinical and radiographic assessment revealed concussion and traumatic mobility of the upper right canine, intrusive luxation of the upper right lateral incisor and extrusive luxation with increased mobility of the upper right central incisor. Taking into consideration treatment alternatives, an orthodontic–endodontic approach was preferred. Conclusions: The successful management of complex dental trauma affecting multiple permanent teeth requires interdisciplinary collaboration. The clinical significance lies in the potential long-term consequences on both tooth function and aesthetics, which can impact patient well-being. Full article

Objectives: To evaluate the role of treatment timing in the management of Class II malocclusions with mandibular retrusion using Twin Block (TB) followed by fixed appliances (FAs). Methods: Forty-one Caucasian patients (22 females and 19 males) with Class II malocclusion treated consecutively with TB and FA were selected from the Orthodontic Clinic of the Careggi University Hospital, Florence, Italy and from a sample treated by a private practitioner in Auckland, New Zealand. According to the Cervical Vertebral Maturation (CVM) method, the subjects were divided into two groups: an early treated group (ETG) including 21 patients (mean age 10.8 ± 2.1 years) who began treatment before the pubertal growth peak (CS1–CS2), and a late treated group (LTG) including 20 patients (mean age 12.4 ± 1.1 years) treated at the growth peak (CS3–CS4). Cephalometric skeletal, dento-alveolar and soft tissue parameters were evaluated before treatment with TB (T0) and at the mid-term observation (at a postpubertal stage CS4–CS6) after FA (T1). Independent samples t-tests were performed to compare intergroup differences at T0 and T1 while Fisher’s exact test was used to assess differences for gender. Results: At T0, the groups showed statistically significant differences in mandibular dimensions, in accordance with the different age distribution. At T1, significant differences between ETG and LTG were observed in Co-Gn (5.0 mm, p = 0.048, 95% Confidence Interval (CI) −9.8 mm; −0.1 mm), Co-Go (3.7, p = 0.009, 95%CI −6.3 mm; −0.9 mm), and Pg′-TVL SN10 (2.7 mm, p = 0.039, 95%CI −5.2 mm; −0.1 mm). Conclusions: Class II treatment with TB and FA confirmed that including the pubertal phase in the functional-orthopedic treatment led to more favorable mandibular growth and chin projection when evaluated at a postpubertal observation. Full article

This research presents an artificial intelligence (AI)-driven 3D scanning and printing system for the fabrication of personalized dental prosthetics, implants, and orthodontic appliances. The proposed system integrates high-resolution intraoral scanning, AI-based data analysis, and additive manufacturing to enhance precision, customization, and treatment efficiency. Patient-specific anatomical data and medical history are incorporated to optimize implant design, material selection, and functional performance. Nano-enhanced biocompatible materials are utilized to improve mechanical strength, durability, and antibacterial properties. Specifically, these materials demonstrate a 30% increase in overall precision and a 50% improvement in durability compared to traditional dental materials. In addition, the system adopts a zero-waste manufacturing strategy by recycling excess materials, supporting sustainable dental practices. The results demonstrate significant improvements in accuracy, patient comfort, and environmental responsibility in modern digital dentistry. Full article

Background: Functional appliance therapy is widely employed for the management of skeletal Class II malocclusion in growing patients. However, treatment outcomes are influenced by multiple biological and behavioural variables, including genetic background, craniofacial growth pattern, neuromuscular adaptability, orofacial resting postures, and patient adherence. These factors often limit direct comparison of different appliance systems. Monozygotic twin studies provide a unique biological model by minimizing genetic and environmental variability, allowing more accurate evaluation of appliance-specific effects. Methods: This case report presents a comparative evaluation of a clear functional jaw corrector and a conventional twin block appliance in two 11-year-old female monozygotic twins at cervical vertebral maturation index stage 3. Both patients exhibited similar skeletal Class II patterns, vertical growth tendencies, proclined maxillary incisors, and convex soft tissue profiles. Twin A was treated with a removable clear functional jaw corrector fabricated using mandibular advancement blocks incorporated into a 1.5-mm Essix retainer sheet, while Twin B received a conventional twin block appliance. Treatment objectives, wear protocol, and duration were identical. Neither patient received orofacial myofunctional therapy. Results: Post-treatment clinical and cephalometric evaluation demonstrated improvement in sagittal jaw relationships, facial profile, and occlusal relationships in both patients. However, differences were observed in the magnitude of skeletal correction, dentoalveolar effects, vertical control, and the extent of molar and canine relationship correction. Conclusions: Both appliance designs were effective in improving sagittal relationships under similar biological conditions, with minor differences favoring the clear functional jaw corrector. However, the findings also highlight that orthodontic appliance therapy alone does not address underlying orofacial myofunctional factors, emphasizing the importance of incorporating functional assessment and adjunctive myofunctional therapy for optimal and stable outcomes. Full article

Background: Malocclusion can influence not only oral function, but also adolescents’ perception of dental appearance, psychosocial status, and oral health-related quality of life. The present cross-sectional study aimed to examine the association between the clinical severity of malocclusion and adolescents’ self-perception, as well as to assess the level of agreement between clinician and patient ratings of aesthetic impairment. Methods: The study included 160 consecutive adolescents aged 12 to 17 years who were referred for orthodontic evaluation. Malocclusion severity was determined using the Index of Orthodontic Treatment Need (IOTN), considering both the Dental Health Component (DHC) and the Aesthetic Component (AC). Patients’ perceptions of malocclusion severity, aesthetic concerns, and functional limitations were collected through numeric rating scales, while psychosocial impact was measured using the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ). Correlations were examined with Spearman’s coefficients, agreement between clinician- and self-rated AC scores was evaluated with weighted kappa statistics, and multivariable regression analyses were used to identify independent predictors of patient-reported outcomes. Results: Moderate positive correlations emerged between IOTN-DHC and self-perceived malocclusion severity (rho = 0.42, p < 0.001), and between clinician-rated IOTN-AC and self-perceived severity (rho = 0.47, p < 0.001). Associations were stronger for aesthetic and psychosocial measures than for functional complaints, with the highest correlation observed between clinician-rated IOTN-AC and perceived aesthetic impact (rho = 0.58, p < 0.001). Greater clinical severity was also associated with increased psychosocial burden, as reflected by higher PIDAQ total scores. Agreement between clinician and patient evaluations of aesthetic impairment was fair to moderate (weighted kappa = 0.34) but improved when AC scores were grouped into broader categories (weighted kappa = 0.46). Overall, adolescents tended to perceive their dental aesthetic impairment as more severe than did clinicians. In the multivariable models, clinician-rated IOTN-AC remained an independent predictor of perceived severity, aesthetic impact, and psychosocial burden. Conclusions: Clinical measures of malocclusion severity and adolescents’ self-perception were significantly related, although they reflected partly different aspects of orthodontic treatment need. Combining normative clinical indices with patient-reported outcomes may allow a more complete and patient-centred evaluation of malocclusion. Full article

Background: Orthodontic treatment is increasingly recognised as a complex, patient-centred intervention whose impact extends beyond occlusal correction to include physical comfort, psychosocial well-being, and self-perceived esthetics. Oral health-related quality of life (OHRQoL) has therefore become a key outcome for evaluating orthodontic care across all treatment stages. Aim: This narrative review of 140 studies synthesises current evidence on OHRQoL changes in orthodontic patients before treatment, during active therapy, and after treatment completion, with particular emphasis on temporal patterns and appliance-related differences. Methods: A comprehensive narrative review of 140 studies was conducted using PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar (search period: inception to December 2025). Studies assessing OHRQoL or patient-reported outcomes in orthodontic patients of any age were included. Only studies employing validated instruments, such as OHIP, CPQ, OIDP, and PIDAQ, were considered. Dual-reviewer agreement was assessed using Cohen’s kappa (κ = 0.82). Formal risk-of-bias assessment was conducted using ROBINS-I for non-randomised studies and the Cochrane Risk of Bias tool for RCTs. Sensitivity analyses were performed comparing high-quality studies (low risk of bias, n = 52) versus all included studies. Results: The reviewed evidence consistently demonstrates that malocclusion is associated with impaired baseline OHRQoL, particularly affecting psychosocial and esthetic domains. The early phase of orthodontic treatment is marked by a transient deterioration in OHRQoL due to pain, discomfort, speech disturbances, and functional limitations (87% of studies report pain peaks within 24–48 h; 79% report resolution by 4–7 days). These effects typically diminish as patients adapt to the appliance. Progressive improvement is observed during mid-treatment, while treatment completion is associated with substantial long-term gains in self-esteem, social functioning, and overall quality of life. Appliance type influences short-term outcomes, with clear aligners generally associated with better early OHRQoL than fixed and lingual systems (65–75% of studies favour aligners for early comfort; 78% favour lingual systems for esthetic satisfaction). Conclusions: Orthodontic treatment follows a dynamic, time-dependent OHRQoL trajectory characterised by short-term impairment and significant long-term psychosocial benefits. Systematic integration of validated OHRQoL measures into orthodontic care may enhance patient-centred decision-making and optimise clinical outcomes. Full article

Background and Objectives: Tooth impaction is a common developmental dental anomaly characterized by the failure of eruption within the expected physiological timeframe. Permanent canines represent the second most frequently impacted teeth after third molars and may lead to functional, esthetic, and orthodontic complications. This systematic review aimed to synthesize current evidence regarding the incidence, anatomical distribution, etiological determinants, and diagnostic evaluation of permanent canine impaction. Materials and Methods: A systematic literature search was conducted in PubMed, PubMed Central, and ScienceDirect for studies published between December 2009 and December 2025. Studies reporting prevalence data, anatomical positioning, etiological factors, or imaging characteristics of permanent canine impaction were included. Study selection followed PRISMA 2020 guidelines, and 31 studies were included in the qualitative synthesis. Two independent reviewers screened titles, abstracts, and full texts. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Tools. Results: Thirty-one studies met the inclusion criteria and were included in the qualitative synthesis. The reported prevalence of maxillary canine impaction ranged from 0.97% to 7.10%, while mandibular impaction occurred less frequently. Palatal displacement represented the most common positional pattern. Major etiological factors included retained deciduous canines, dental arch constriction, supernumerary teeth, odontomas, and genetic anomalies such as lateral incisor agenesis. Cone-Beam Computed Tomography (CBCT) demonstrated superior diagnostic accuracy compared with panoramic radiography. Conclusions: Permanent canine impaction is a multifactorial condition predominantly influenced by local anatomical and environmental factors, with genetic predisposition acting as a secondary contributor. Early diagnosis and appropriate imaging assessment are essential to prevent complications such as root resorption and to optimize treatment outcomes. Full article

Background: The interrelationship between craniofacial morphology and respiratory function is a central focus of orthodontic and dentofacial orthopedic research. This study aimed to evaluate the volumetric changes in the sinonasal complex (combined nasal cavity and paranasal sinuses) following Right Angle Maxillary Protraction Appliance (RAMPA) therapy using cone-beam computed tomography (CBCT) and to compare these outcomes with established longitudinal growth benchmarks. Methods: A retrospective cohort analysis was conducted on 60 pediatric patients (24 males, 36 females; mean age: 86.60 ± 24.22 months) with radiologically clear paranasal sinuses at baseline (T1). Participants underwent RAMPA therapy for an average of 8.38 months. Volumetric quantification of the entire sinonasal complex—including the nasal cavity and all four paranasal sinuses (maxillary, ethmoid, sphenoid, and frontal)—was performed to ensure methodological alignment with existing normative growth data. Results: Total sinonasal volume increased significantly from 27,741.63 ± 10,675.85 mm³ at T1 to 32,248.00 ± 10,084.07 mm³ at T2 (p < 0.001), representing a mean gain of 4506.37 mm³ (16.24%). Notably, the annualized growth velocity under RAMPA therapy (6453 mm³/year) exceeded the physiological increment of age-matched normative data (~5418 mm³/year) by approximately 1.2 times. Despite a constricted baseline at T1 compared to normative values, the treatment group demonstrated a rapid “catch-up” growth trajectory. Conclusions: RAMPA therapy induces rapid and significant volumetric expansion of the sinonasal complex in pediatric patients, demonstrating a potent “acceleration effect” that surpasses natural physiological maturation. These findings suggest that orthopedic midfacial remodeling can effectively restructure the upper respiratory environment, bridging the gap between pathological constriction and normative developmental benchmarks in patients with maxillary hypoplasia. Full article

Background: The anatomical position of the hyoid bone and the morphological characteristics of the soft palate play a key role in upper airway patency, craniofacial balance, and the coordination of functional structures. These features may vary depending on skeletal pattern and gender. This study aimed to evaluate the relationship between hyoid bone position, soft palate morphology, skeletal classification, and gender using lateral cephalograms. Methods: A total of 120 individuals (60 females and 60 males) were classified as Skeletal Class I, II, or III based on the ANB (A Point–Nasion–B Point) angle. Measurements reflecting hyoid position and pharyngeal airway width were analyzed, including C3–H (distance from the third cervical vertebra to the hyoid bone), C3–RGn (distance from the third cervical vertebra to retrognathion), H–RGn (distance from the hyoid bone to retrognathion), PNS–UPW (distance from the posterior nasal spine to the upper pharyngeal wall), and U–MPW (distance from the uvula to the middle pharyngeal wall). Soft palate types were classified according to the You classification. Statistical analyses included ANOVA (analysis of variance), the Kruskal–Wallis test, the independent samples t-test, the Mann–Whitney U test, and the chi-square test. Results: Significant differences in C3–RGn, H–RGn, and U–MPW were observed between Skeletal Classes I–III and Classes II–III (p < 0.05). In contrast, C3–H and PNS–UPW did not differ significantly among skeletal classes. Soft palate types showed no significant association with skeletal classification or gender. Gender-based comparisons revealed significant differences in C3–H, C3–RGn, H–RGn, and PNS–UPW (p < 0.05). Conclusions: Mandibular-related hyoid measurements and the U–MPW parameter were associated with skeletal pattern, whereas C3–H and PNS–UPW remained relatively stable. Soft palate morphology was not significantly influenced by skeletal class or gender. These findings suggest that the hyoid–tongue–soft palate complex should be evaluated in conjunction with mandibular position during orthodontic diagnosis and treatment planning. Full article

Background/Objectives: The achievement of stable and functional occlusal contacts represents a key objective of orthodontic treatment, particularly in growing patients. Evidence comparing the effectiveness of these two modalities in establishing adequate occlusal contacts in growing patients remains limited. This study aimed to evaluate and compare occlusal contact characteristics following clear aligner therapy (CAT) and fixed orthodontic therapy (FAT). Methods: Twenty-four growing patients (<18 years with permanent dentition) were included in the study and divided into two groups: 12 patients treated with fixed appliances and 12 treated with clear aligners. Post-treatment digital dental scans were analyzed to assess occlusal contacts. Contacts were calculated as the minimum distance between upper and lower arches using a color-map analysis. The following outcomes were evaluated: Maximum Contact Point (MCP), occlusal contact surface (OCS, ≤50 μm from MCP), near occlusal contact surface (NOCS, ≤350 μm), half mm (≤0.5 mm), and one mm (≤1 mm). Total occlusal contacts, antero-posterior distribution, left–right asymmetry, and single-tooth contacts were assessed. Results: The FAT group showed higher total occlusal contact values in OCS compared to the CAT group (p < 0.05). Statistical difference was also observed in the antero-posterior ratio, with FAT presenting fewer anterior contacts in OCS, NOCS, half-mm, and one-mm measurements (p < 0.05). No significant differences were found between groups in terms of left–right asymmetry or post-treatment single-tooth contacts, except for the second premolar, which exhibited higher contacts in the FAT group (p < 0.05). Conclusions: Fixed orthodontic treatment is more effective than aligners in achieving adequate occlusal contacts, with differences limited to tight contacts and antero-posterior occlusal distribution. Full article

Background: Intermaxillary elastics are widely used in orthodontics to deliver controlled forces for malocclusion correction, aiding in the correction of anteroposterior, vertical, or transverse problems. Despite their clinical relevance, comprehensive mechanical characterization remains limited. Objective: This study aimed to evaluate the mechanical properties of nine types of intermaxillary elastics available on the market to guide evidence-based clinical selection. Methods: Elastics were tested under uniaxial tensile loading following ISO 37:2011 and ISO 21606:2007, with six replicates per type. Load–displacement and stress–strain responses were analyzed, measuring peak force, elongation at rupture, work-to-rupture, and specific rupture work. Non-linear behavior was modeled using cubic polynomial regression, and normalized stress–strain curves enabled intrinsic material comparisons. One-way ANOVA with post-hoc tests assessed differences among elastics. Results: All elastics displayed characteristic non-linear elastomeric responses. Functional grouping distinguished short-displacement/high-stiffness, intermediate-displacement/moderate-stiffness, and long-displacement/high-capacity bands. Work-to-rupture, specific rupture work, and normalized stress–strain metrics varied significantly, reflecting differences in energy absorption and force delivery (p < 0.05). Conclusions: Mechanical characterization, including energy-based descriptors and normalized stress–strain analysis, supports informed elastic selection, enhancing orthodontic treatment predictability and patient safety. Full article