Search Results (524)

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: Fixed orthodontic appliances interfere with oral hygiene and contribute to plaque retention, gingival inflammation and demineralization of enamel. Standard techniques for keeping oral hygiene (tooth brushing, mouthwashes, dental floss, interdental brush, etc.) are not sufficiently effective. The aim of this study was to investigate the effectiveness, safety, tolerability, and influence on quality of life of an electrolysis device being added to standard techniques of oral hygiene in orthodontic patients, compared to standard methods only. Methods: This 6-month study was designed as an observational prospective-cohort investigation. Primary outcomes of the study were indices of gingival inflammation and bleeding, dental plaque indices, the number of white spots on enamel, and safety (incidence of adverse events). Secondary outcomes were quality of life and overall costs of keeping oral hygiene. Results: The addition of the Neo Pill device to standard oral hygiene maintenance measures was associated with improvements in oral health indices after 6 months; however, given the non-randomized, preference-driven design, these findings reflect an association and should not be interpreted as evidence of causal efficacy. After 6 months, the primary outcomes of the study were significantly reduced compared to the application of only standard oral hygiene methods (from 21 to 55% reduction); the quality of life related to oral health was higher (for 14%), the tolerability of maintaining oral hygiene was the same as with standard measures and the costs of maintaining oral hygiene consumables were lower in the Neo Pill group (median difference 30%); however, this figure excludes the acquisition cost of the device itself, which was donated to all participants by the manufacturer, and the 95% confidence interval for this difference includes zero. Conclusions: The addition of an electrolysis device to standard oral hygiene maintenance measures in people wearing fixed orthodontic appliances was associated with improvements in gingival inflammation, papillary bleeding, and dental plaque indices—outcomes measured with established clinical instruments. Apparent reductions in white-spot lesion counts were also observed but should be considered exploratory given the absence of calibrated or blinded lesion assessment. These findings are preliminary and do not establish causal efficacy. Full article

Idiopathic root resorption is diagnosed when external root resorption occurs in the absence of an identifiable etiological factor. Two main forms are described in the literature: apical and cervical. Owing to the rarity of this condition and the limited number of published reports, evidence-based recommendations for orthodontic management are currently lacking. The aim of this study was to provide a narrative overview of published case reports describing orthodontic procedures performed in patients with idiopathic root resorption and to supplement the available literature with a detailed clinical case. A case of a 7-year-7-month-old female patient presenting with generalized idiopathic root resorption and a concomitant skeletal Class III malocclusion is described. In this patient, skeletal anchorage was used to support maxillary protraction in an attempt to obtain an orthopedic effect. The literature review had a narrative character and was based on a structured search of the PubMed, Scopus, and Web of Science databases covering the period from January 2010 to December 2025. Only English-language case reports meeting strict eligibility criteria were considered. Of 47 records initially identified, two fulfilled the inclusion criteria; an additional two case reports were retrieved through manual searching. Conclusions: Given that the available evidence is limited to isolated case reports and a single clinical observation, the present findings do not allow for reliable conclusions regarding the safety, effectiveness, or general applicability of orthodontic treatment in patients with idiopathic root resorption. Clinical management should therefore be individualized, with careful documentation and close radiological follow-up. Further well-documented clinical reports are required to better characterize treatment-related risks in this patient group. Full article

Objective: Skeletal mandibular asymmetry (MA) is a pathological condition characterised by asymmetric mandibular growth, resulting in chin deviation and, in some cases, non-coincident dental midlines. Because it is a skeletal condition, some clinicians choose to treat it with functional appliances. The present study therefore evaluated whether functional appliances with asymmetric activation can promote more symmetrical growth of the mandibular condyles and rami. Methods: Eighty-five patients with MA were retrospectively selected based on cervical skeletal maturation stage 2 or 3, the presence of skeletal and dental Class II malocclusion, and the availability of good-quality orthopantomograms taken before and after treatment. Among the enrolled patients, 40 were treated with functional appliances to protrude and re-centre the mandible (study group), while 45 were treated only with a rapid maxillary expander (positive and treated control group). This control group was chosen because it has no direct effects on the mandible and avoided the ethical concerns associated with postponing time-sensitive treatment to recruit a negative control group. Ramus and condyle asymmetry were evaluated pre- and post-treatment using Habets’ method. The Mann–Whitney U-test was used to compare pre- and post-treatment asymmetry indices between the two groups. Results: Although both groups showed a post-treatment symmetry improvement, no statistically significant between-group differences were observed (p = 0.712, effect size r = 0.14 for ramal symmetry; p = 0.663, effect size r = −0.01 for condylar symmetry). Conclusions: Within the limitations of this study, functional appliances did not demonstrate greater skeletal effects than the positive control treatment. Full article

Background and Objectives: Conventional stainless-steel orthodontic molar bands may exhibit limited anatomical adaptation, favoring plaque retention and periodontal inflammation. This study aimed to compare the periodontal outcomes of standard bands and CAD/CAM-customized molar bands in adolescents. Materials and Methods: A prospective randomized controlled clinical study was conducted in 180 adolescents (mean age: 11.9 years) undergoing fixed orthodontic therapy. Participants were allocated to CAD/CAM-customized bands (n = 90) or standard stainless-steel bands (n = 90). Periodontal parameters—Plaque Control Record (PCR), Bleeding on Probing (BOP), and Periodontal Probing Depth (PPD)—were assessed at baseline, 1, 3, and 6 months. Data were analyzed using the Mann–Whitney U test (p < 0.05). Results: Baseline values were comparable between groups (p > 0.05). During follow-up, the CAD/CAM group showed significantly lower PCR, BOP, and PPD values. At 6 months, PCR was 21 ± 8% vs. 42 ± 12%, BOP was 17 ± 6% vs. 40 ± 10%, and PPD was 2.5 ± 0.5 mm vs. 3.1 ± 0.6 mm (all p < 0.001). Conclusions: CAD/CAM-customized molar bands demonstrated superior periodontal performance compared with conventional bands. Improved anatomical adaptation may reduce plaque accumulation and gingival inflammation during orthodontic treatment. Full article

Background: Effective pain management is crucial during orthodontic treatments with fixed appliances, to ensure adequate patient compliance and to avoid treatment discontinuation. Photobiomodulation approaches, including Low Level Laser Therapy (LLLT) has received substantial attention, due to its potential as an effective, non-pharmacological analgesic modality, however, evidence pertaining to its efficacy is controversial. Our present study aims to evaluate the efficacy of LLLT vs. placebo, following placement of orthodontic elastic separators (ESs) in adult patients treated with fixed orthodontic appliances. Methods: A randomized, double-blind, split-mouth study was carried out, where n = 31 volunteers (18 male and 13 female; aged between 19 and 32 years) were enrolled. ESs were placed at the mesial and distal surfaces of the first permanent molars in both quadrants of lower, as well as upper jaws. Based on the assigned intervention, the four quadrants were divided as follows: three quadrants received LLLT treatment—using a 980 nm wavelength GaAlAs diode laser, with 0.1–0.2 W—according to three treatment regimes, i.e., regime 1 (R1): 6 J, continuous mode, R2: 12 J, continuous mode, and R3: 6 J, pulsed mode; while placebo treatment (P) was applied in the fourth quadrant. A questionnaire with a visual analogue scale (VAS; 0–100) was used for pain assessment (spontaneous pain and pain on mastication), scored directly after separation and after 6, 24, 48 and 72 h of both laser and placebo treatment application. Results: After the 24 h mark, significant differences were detected between the pain readings of LLLT-treated and placebo quadrants, both in resting position and during mastication (p < 0.05); pain readings were highest for R2, P, while lowest for R3 quadrants in resting position, and at R1 during mastication, respectively. Conclusions: Although findings of our study are exploratory in nature, they suggest that a single application of LLLT might be effective in reducing pain caused by ES placement, especially in the vulnerable 24 h following separation. Trial registration: clinicaltrials.gov ID NCT07456709 (date of registration: 2 March 2026, retrospectively registered). Full article

Background/Objectives: Multiple impacted teeth are defined as the sequential impaction of more than two teeth in the alveolar bone, whether unilateral or multilateral. Multiple impactions are an uncommon and rare phenomenon demanding thorough treatment planning and careful execution, but data on the prevalence of multiple impactions is scarce in the literature. In cases of multiple impactions, clinicians generally perform a 3D assessment using CBCT to determine tooth positions, establish a sequence of surgical exposures, implement suitable traction, and utilise appropriate biomechanics. A multidisciplinary approach between orthodontists and oral surgeons is essential to achieve optimal results. Methods: This case report presents non-syndromic multiple impactions of three upper left permanent anterior teeth—21, 22, and 23—along with a retained supernumerary tooth preventing their eruption and a fused primary tooth. The primary teeth and the impacted supernumerary tooth were surgically removed. A digitally designed transpalatal arch was used to preserve the space and to act as anchorage for the orthodontic traction. After an 8-month observational period without spontaneous eruption, surgical exposure was carried out using the closed exposure technique. Subsequently, elastic traction was performed, guiding the impacted teeth into the dental arch. Results: The multiple impacted teeth were successfully aligned in the dental arch, achieving symmetry in the frontal segment while preserving periodontal health. In order to ensure stability during the retention period, thermoformed retainers were used. Conclusions: Each complex and rare clinical case poses a challenge to orthodontists and is important for the scientific literature as it provides valuable clinical experience. Full article

Background/Objectives: Photobiomodulation (PBM) is a biologically plausible adjunct for modulating orthodontic tissue response, but its role in conventional clear aligner therapy remains uncertain. This narrative review summarises the mechanistic rationale and clinical evidence on PBM used with clear aligners, focusing on treatment efficiency, predictability, patient-centred outcomes, and biological safety. Methods: Scopus was searched using PBM/low-level laser terms combined with orthodontics and clear aligners. Titles and abstracts were screened for human studies evaluating PBM as an adjunct to conventional staged clear aligner therapy and reporting treatment duration or alignment efficiency, tracking/predictability (for example, additional aligners, refinements, or fit-related outcomes), pain, or biological safety. Eight aligner-based clinical studies formed the core set. Results: The included studies comprised case reports, retrospective cohorts, pilot investigations, and one historical prospective nonrandomized comparison. Most evaluated short daily sessions of home-use near-infrared LED PBM, while some used external laser-based or combined adjunct protocols. Some studies reported shorter treatment duration, faster alignment, or fewer finishing aligners in PBM users, but these findings were difficult to attribute to PBM alone because altered tray-change intervals and close monitoring were common co-interventions. Aligner-specific pain outcomes were inconsistently reported. Limited safety data, based mainly on one retrospective pilot cohort assessing anterior teeth, found no statistically significant difference in root-volume change between PBM users and controls. Conclusions: PBM has been investigated as a potential adjunct in clear aligner orthodontics, but the available evidence remains preliminary, heterogeneous, and largely non-randomised. No high-quality randomized clinical evidence currently supports the clinical effectiveness or routine use of PBM in clear aligner orthodontics. At present, PBM should be regarded as an investigational adjunct rather than an established clinical recommendation, pending larger and better-designed trials with standardised device-specific protocols, objective adherence measures, movement-specific analyses, and longer follow-up for safety and patient benefit. Full article

Background: Orthodontic camouflage in Class III patients is a widely used treatment approach. However, its application is subject to specific clinical indications. This narrative review aims to synthesize the current scientific evidence and provide an overview of the available methods, their advantages and limitations, in order to guide the appropriate management of Class III camouflage cases. Methods: A literature search was carried out using five main scientific databases without restrictions. Inclusion criteria were all types of articles published on various orthodontic camouflage techniques for Class III malocclusion in adult patients. The string searches included “camouflage” and “Class III malocclusion”. In addition, a manual search was performed to identify further relevant articles. The methodological quality was assessed using the Oxford Centre for Evidence-Based Medicine (OCEBM) classification. Results: This narrative review synthesizes 128 studies on orthodontic camouflage in adult Class III malocclusion. Among the 128 articles included, 110 (86%) were case reports or small case series, corresponding to level 4–5 evidence. The remaining studies were observational in design, most of them retrospective, corresponding to level 2–3 evidence. Extractive or non-extractive treatment can be used for non-surgical treatment of a Class III in adults. In recent years, aesthetic techniques, such as clear aligners or lingual fixed appliances, have been efficiently performed. Carriere Motion III is a fast and efficient method to mask a Class III occlusal relationship. Moreover, the use of temporary anchored devices (TADs) has proven to be an effective and minimally invasive method for managing mandibular distalization and a retraction of the lower incisors. Conclusions: Although most reports are case-based, recent advances such as TADs and clear aligners offer effective non-surgical alternatives for selected mild-to-moderate cases. Careful patient selection remains critical. The evidence was low-quality, and further prospective studies are needed. Full article

Background/Objectives: This study evaluated the effectiveness of Cotinus coggygria (Smoke Tree) Flower Water mouthwash in reducing halitosis and improving oral hygiene parameters among adolescents undergoing fixed orthodontic treatment. Methods: A double-blind, randomized, placebo-controlled, parallel-group clinical trial was conducted with 30 individuals undergoing treatment with fixed orthodontic appliances. Participants were allocated (1:1) into two groups: Group A received the Cotinus coggygria mouthwash, while Group B received the placebo mouthwash. Hydrogen sulfide (H₂S) concentration in breath, measured by the OralChroma^TM II device, was the primary outcome. Secondary outcomes included dimethyl sulfide [(CH₃)₂S] and methyl mercaptan (CH₃SH) levels, assessed with the same device, and oral hygiene status evaluated using the Modified Silness & Löe Plaque (PI-M) as well as the Silness & Löe Gingival (GI) indices. Normality of the data distribution was assessed using the Shapiro–Wilk test. Statistical analyses were conducted using the Mann–Whitney U test and Student’s t-test. Results: A statistically significant reduction in H₂S levels was observed in the C. coggygria group compared to placebo (p = 0.014). Median H₂S levels decreased from 147.00 ppb at baseline (T0) to 35.00 ppb at follow-up (T1) after 2 weeks. A statistically significant reduction in total VSC levels was also observed in the C. coggygria group compared to placebo (p < 0.001). Median total VSC levels decreased from 254.00 ppb at baseline (T0) to 105.00 ppb at follow-up (T1) after 2 weeks. No significant differences were found between groups for the other volatile sulfur compounds. A Significant improvements were noted in periodontal parameters in favor of the C. coggygria group. The Gingival Index decreased from 2.0 to 1.3 (p < 0.001; 95% CI: −0.7 to −0.2), and the Plaque Index (PI-M) decreased from 1.6 to 1.0 (p = 0.001; 95% CI: −0.7 to −0.3). Conclusions: Cotinus coggygria mouthwash appeared to be an effective adjunct for managing halitosis and improving oral hygiene parameters in adolescents undergoing fixed orthodontic treatment. No adverse effects were reported. 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

Background: This retrospective case series evaluated the descriptive clinical observations of the bio-activator AMCOP^® TC in the treatment of growing patients with Class III dento-skeletal malocclusion. In recent years, elastodontic appliances have been introduced as an evolution of conventional functional appliances. Elastodontic therapy could be an excellent therapeutic alternative in the early treatment of patients with Class III dento-skeletal malocclusion. Aim: This retrospective experimental study evaluated the descriptive clinical observations of the bio-activator AMCOP^® TC in the treatment of patients with Class III dento-skeletal malocclusion and described four clinical cases. Materials and methods: The study included 11 subjects (5 males and 6 females, aged between 3 and 12 years) treated with the AMCOP^® TC bio-activator for Class III dento-skeletal malocclusion. Patients used the AMCOP^® TC device for two hours in the afternoon and all night for 6–8 months and then only at night. For each patient, cephalometric analyses were performed on latero-lateral teleradiographs both at the beginning of treatment (T0) and at the end of treatment (T1). Analyses were performed using DeltaDent^® software. Conclusions: Cephalometric observations between T0 and T1 showed changes in sagittal relationship parameters, including ANB values; however, these findings should be interpreted cautiously. Elastodontic therapy with an AMCOP^® TC appliance improved the correction of a Class III dento-skeletal malocclusion and postural restoration of the first cervical vertebrae. Although further studies are needed, AMCOP^® TC bio-activators may be considered a possible interceptive treatment approach in selected growing patients; however, the present findings should be interpreted with caution. Findings should be considered preliminary and interpreted with caution. 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: 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