Search Results (192)

The selection of an appropriate fixation system is critical for maintaining postoperative stability after sagittal split ramus osteotomy (SSRO), especially in cases involving large mandibular advancements and counterclockwise rotation, where mechanical stresses may compromise treatment outcomes. This in vitro study evaluated the biomechanical stability of five fixation systems following sagittal split ramus osteotomy (SSRO) under two mandibular advancement conditions. Fifty polyurethane hemimandibles were allocated into two experimental groups: Group 1, submitted to 10-mm linear advancement, and Group 2, submitted to 10-mm advancement associated with 20° counterclockwise rotation. Each group was further divided into five subgroups according to the fixation design employed: (A) conventional straight plate, (B) angled plate, (C) sagittal plate, (D) 10-hole miniplate, and (E) two 4-hole miniplates. Biomechanical performance was assessed by compression testing using a universal testing machine. Complementary analyses were performed using strain gauges and digital image correlation. Group 1 in fixation B, C and D demonstrated higher biomechanical resistance than Group 2, however without significance difference. Among the evaluated configurations, subgroup E exhibited the highest resistance values in both experimental conditions. Statistically significant differences were observed among fixation systems within each group (p < 0.05). The fixation systems using two miniplates demonstrated superior biomechanical stability, particularly in mandibular advancements associated with counterclockwise rotational movements. These findings suggest that this fixation strategy may contribute to enhanced postoperative stability in orthognathic surgery involving large mandibular advancements and complex rotational movements. Full article

Objectives: This study aimed to evaluate and compare the cost-effectiveness of the surgery-first and orthodontic-first approaches in Thai patients with dentofacial deformities undergoing orthognathic surgery. Methods: This retrospective cohort study included 30 patients with dentofacial deformities, divided into the surgery-first approach (SFA, n = 15) and orthodontic-first approach (OFA, n = 15). All underwent double-jaw surgery without genioplasty performed by a single surgeon and orthodontist. Data collected included operative and orthodontic costs, operative time, total treatment and hospital costs, treatment duration, and length of hospital stay. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER) and incremental time-effectiveness ratio (ITER), with effectiveness measured by quality of life via the Thai Orthognathic Quality of Life Questionnaire (OQLQ) before and at the time of debonding the orthodontic appliance. Results: Overall, the SFA demonstrated greater cost-effectiveness than the OFA. However, the SFA group incurred slightly higher hospital costs. There were no statistically significant differences between the two groups in operative cost, hospital cost, total cost, operative time, or length of hospital stay (p > 0.05). By contrast, orthodontic cost, orthodontic treatment duration, and total treatment duration were significantly lower in the SFA group compared with the OFA group (p < 0.05). Conclusions: Within limits, the SFA is a potentially beneficial alternative to OFA. Patients and clinicians may benefit from using SFA by experiencing shorter treatment duration, lower orthodontic treatment costs, and improvements in certain aspects of quality of life. Further studies with larger sample sizes and longitudinal data are necessary to establish the long-term effectiveness. Full article

Background: Unilateral progressive condylar growth (UPCG) represents a complex clinical condition characterized by abnormal enlargement of the mandibular condyle, leading to progressive facial asymmetry and functional impairment. Objectives: The aim of this review is to analyze the biological, clinical, and therapeutic factors guiding condylectomy, assess the current role and scope of proportional condylectomy, and propose an algorithm to guide its indication in patients with UPCG. Methods: A narrative review was conducted to analyze the biological, clinical, and therapeutic factors involved in the indication for condylectomy in patients with progressive unilateral condylar growth. Studies including patients diagnosed with unilateral condylar hyperplasia or condylar osteochondroma who underwent surgical treatment were considered to evaluate clinical indications, timing of intervention, and outcomes. Special attention was given to the concept of proportional condylectomy. Results: Current evidence indicates that early intervention may control disease progression, reduce the severity of residual deformity, and minimize the need for secondary orthognathic surgery. The integration of clinical findings, three-dimensional imaging, and patient-specific factors is essential for appropriate treatment planning. Conclusions: Based on these considerations, a structured clinical algorithm is proposed to guide decision-making in patients with unilateral progressive condylar growth. This approach supports individualized treatment strategies aimed at optimizing functional and esthetic outcomes. Full article

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

Background/Objectives: Artificial intelligence (AI) has gained growing interest in the field of orthognathic surgery due to its potential to improve diagnostic accuracy, surgical planning, and treatment outcomes. This scoping review maps literature from 2017 to May 2025 to identify AI applications in orthognathic surgery, assess their clinical relevance, and discuss the associated ethical, legal, and technical limitations. Methods: This scoping review further examines the stages of the orthognathic surgical workflow at which AI applications have been prospectively validated, the artificial intelligence methodologies applied to virtual surgical planning and outcome prediction, and the main methodological, ethical, and legal factors that may constrain broader clinical adoption. Results: A total of 62 studies were included, covering AI use in cephalometric analysis, virtual surgical planning (VSP), outcome prediction, and intraoperative support. While AI demonstrates remarkable potential in orthognathic planning, current approaches are often limited by heterogeneous methodologies and retrospective validation. Conclusions: Future studies should prioritize prospective, multicentre designs integrating AI-assisted decision-making directly into the clinical workflow, with emphasis on model interpretability, patient-specific accuracy, and ethical transparency. These questions extend beyond mapping applications by emphasizing clinical validation, methodological rigor, and ethical accountability—dimensions insufficiently explored in prior reviews. Full article

Objective: To describe the experience of use of laser photobiomodulation in the management of orofacial neurosensory alterations and its clinical outcomes in a series of cases at a public university clinic in Northeast Brazil. Methods: A retrospective case series study was conducted using secondary data from 125 patients treated at the Biophotonics Center of the Federal University of Bahia between 2003 and 2019, all with a confirmed diagnosis of orofacial neurosensory alterations and who were referred to the service by other primary healthcare units in the municipality. Data collection included sociodemographic characteristics, clinical and dental history, and the main patient complaint. The therapeutic protocol consisted of infrared diode laser application (λ 700–808 nm) in continuous mode, performed every 48 h, totaling 12 individualized sessions per treatment cycle. Sensory evolution was monitored using the inverted Visual Analog Scale (VAS). Patients quantified their perceived sensitivity and discomfort at each session, assigning values from 0 to 10, and monitored symptom progression and treatment response over time. Data were analyzed using descriptive and analytical approaches. The study was approved by the Research Ethics Committee of UFBA (protocol 60327516500005024). Results: Tooth extraction was the most frequently reported etiological factor (60%), with an average of three treatment cycles per patient. At the end of follow-up, 67% of individuals reported changes in symptoms, including partial or complete resolution. Cases associated with orthognathic surgery required more treatment cycles; however, no statistically significant association was observed between the number of cycles and the reported outcomes. Conclusions: Laser photobiomodulation has been employed as a therapeutic approach in the management of orofacial neurosensory alterations in this clinical setting. The findings describe patterns of use and the distribution of patient-reported outcomes. Given the observational design, the results do not allow for causal interpretation or inference regarding treatment effectiveness. Full article

Background/Objectives: This study aimed to evaluate whether patients’ decisions to undergo orthodontic–surgical treatment for dentofacial deformity are associated with Orthognathic Quality of Life Questionnaire (OQLQ) scores, and to identify which domains show the strongest relationship with treatment acceptance. Methods: Adult patients (≥18 years) who were offered orthognathic surgery by the same orthodontic specialist team completed the Hungarian version of the OQLQ. The primary outcome was whether the patient proceeded with surgery following consultation (yes/no). The questionnaire comprises 22 items across four domains, from which domain-specific and total scores (range: 0–88) were calculated. Given the non-normal distribution and group imbalance, comparisons between groups were performed using nonparametric tests, and associations were further evaluated using Firth penalized logistic regression adjusted for age and sex. Results: A total of 133 patients were included, of whom 107 proceeded with surgery and 26 did not proceed. Median total OQLQ scores were higher in the surgery group than in the decline group (40.0 [IQR: 27.0–52.0] vs. 31.5 [16.0–52.5]), although this difference was not statistically significant. In adjusted analyses, the total OQLQ score was not independently associated with treatment acceptance. Among the domains, only facial aesthetics showed a modest association that reached statistical significance (OR per 1-point increase: 1.10; 95% CI: 1.002–1.22). Conclusions: In this single-center cross-sectional study, OQLQ scores showed only a limited association with treatment acceptance. The observed effect was modest, and only the facial aesthetics domain demonstrated a statistically significant relationship, with a confidence interval close to unity, indicating a borderline and potentially unstable association. These findings suggest that patient-reported quality of life alone is insufficient to explain treatment decisions. The OQLQ may be useful as a supportive tool in clinical consultation, particularly for identifying concerns related to facial appearance, but should not be used as a standalone predictor of whether patients proceed with surgery. Full article

Background: Artificial intelligence (AI) is increasingly utilized in orthodontics for diagnosis, treatment planning, and clinical management. Nevertheless, considerable variation persists in orthodontists’ knowledge, attitudes, utilization patterns, recommendations, and concerns regarding AI. The aim of this scoping review was to synthesize survey-based evidence on orthodontists’ perceptions and experiences with artificial intelligence. Methods: A systematic literature search was performed in PubMed, Embase, Scopus, and Web of Science to identify survey-based studies evaluating AI awareness, applications, attitudes, recommendations, and concerns among orthodontists, residents, postgraduate students, and academicians. Results: Seven studies involving a total of 1772 participants were included. Overall, postgraduate students and practicing clinicians demonstrated relatively limited knowledge of AI, whereas academicians exhibited a higher level of awareness. Although routine clinical implementation of AI remains limited, it was most frequently applied—or perceived as beneficial—in cephalometric and cone beam computed tomography (CBCT) analysis, orthognathic surgery planning, and treatment outcome prediction. The majority of participants supported the promotion of AI and the integration of AI education into orthodontic curricula. However, concerns persisted regarding insufficient technical expertise, high costs, ethical and legal challenges, reduced patient engagement, and the potential for diagnostic or procedural errors. Consistent variations related to age and professional role were observed across studies among academicians, postgraduate students, orthodontists, and residents. Conclusions: This scoping review seems to suggest a growing interest in and generally positive attitudes toward AI among orthodontists and trainees. However, the evidence base is limited to a small number of studies, heterogeneous and predominantly based on cross-sectional survey data. For these reasons, findings should be interpreted cautiously. Variability in knowledge and use persists, and integration into practice remains inconsistent. Further research is needed to support effective and evidence-based implementation. Full article

Background: Management of skeletal Class III malocclusion of maxillary origin in late adolescence remains challenging, as conventional tooth-borne orthopedic approaches show reduced effectiveness at advanced stages of skeletal maturation. Minimally invasive, bone-anchored alternatives supported by digital workflows may improve clinical feasibility and patient acceptance. Objective: To describe a digitally guided clinical protocol combining a hybrid maxillary expander and supragingival mandibular miniplates, and to explore skeletal and dentoalveolar outcomes in late adolescents. Methods: This retrospective pilot clinical study included ten late adolescents (mean age 16.0 ± 1.3 years; range 13.8–17.7) in advanced skeletal maturation stages (CS4–CS6) with skeletal Class III malocclusion of maxillary origin. Treatment consisted of a hybrid maxillary expander anchored to palatal miniscrews and custom supragingival mandibular miniplates, placed using a fully digital workflow. Maxillary protraction was performed using a modified Alt-RAMEC protocol followed by continuous intermaxillary elastic traction for 12 months. Pre- and post-treatment cephalometric analyses were conducted. Results: A significant increase in SNA was observed (mean +6.1°, p < 0.001), indicating forward maxillary displacement. The Wits appraisal improved by 3.3 mm (p = 0.007), and the SeMax increased by 2.9 mm (p = 0.0013). No significant changes were found in the SNB or mandibular plane angle. Dentoalveolar effects were limited. Conclusions: Within the limitations of this pilot clinical study, the proposed digitally guided protocol demonstrated clinically relevant maxillary advancement with minimal dentoalveolar side effects and preserved vertical control. This relatively minimally invasive approach compared to conventional subgingival miniplates and orthognathic surgery may represent a feasible treatment option for selected late adolescent patients. Further controlled studies are required to confirm these findings. Full article

Background/Objectives: Unilateral condylar hyperplasia is an idiopathic condition that causes facial asymmetry and occlusal problems. Currently, traditional treatment protocol is the combination of orthognathic and extra-oral condylectomy surgery via pre-auricular incision, which can create aesthetic problems with additional risks of facial nerve damage. The purpose of this study was to report management of condylar hyperplasia patients through minimally invasive condylectomy that was planned via virtual methods. Methods: The custom-made cutting guides were produced, and unilateral condylectomy operations were performed via intra-oral approach. Orthognathic surgery with/without genioplasty operations were either done with condylectomy in one session or in an additional session. Results: Custom-made cutting guides produced by virtual methods provided easy operations without any need for additional extra-oral incisions. Planned osteotomies were transferred successfully from the virtual surgical plan and resections of the excess bone tissues were performed using novel piezo surgery devices. The bones were fixed to their pre-planned position using 3D-printed titanium plates. The patients healed without any complications. Results of this innovative virtually guided protocol tested showed functional and esthetic results without any extra-oral scars with no facial nerve damage. Conclusions: Combination of intra-oral condylectomy with orthognathic surgery using 3D-printed titanium cutting guides seems to be an advantageous approach with successful results in terms of aesthetics and function for management of mandibular condylar hyperplasia patients; however, there is an urgent need in the scientific literature for further clinical research with a larger number of subjects. Full article

Background: In orthognathic surgery planning, two main approaches are commonly used: the conventional orthodontic–surgical (COS) approach and the surgery-first (SF) protocol. The aim of this study was to comparatively evaluate trabecular bone changes in the mandibular condylar, angular, and molar regions following COS and SF protocols using fractal analysis (FA). Methods: A total of 40 individuals (21 females, 19 males) who underwent bilateral sagittal split ramus osteotomy and Le Fort I osteotomy were included in the study. Patients were divided into COS and SF groups. Trabecular changes in the mandibular osteotomy line, condylar, and angular regions were evaluated on panoramic radiographs using FA, and fractal dimension values were calculated using the box-counting method. Results: No statistically significant differences were found between the groups in terms of baseline and post-treatment FA values in the molar and angular regions (p > 0.05). In contrast, a statistically significant difference was observed between the groups in the condylar region (p ≤ 0.05). The total treatment duration was significantly shorter in the SF group (p < 0.05). Conclusions: FA findings reveal that COS and SF protocols show similar effects in terms of mandibular bone healing, but the surgery-first approach is preferable due to its clinical advantages. Full article

Background/Objectives: Virtual surgical planning (VSP) allows three-dimensional assessment of complex dentofacial deformities and has become integral to modern orthognathic surgery. However, evidence remains limited regarding how skeletal characteristics and malocclusion patterns translate into surgical movement selection. This study aimed to evaluate demographic features, skeletal malocclusion patterns, and clinical treatment strategies in patients undergoing VSP-guided orthognathic surgery. Methods: This retrospective study included 158 patients who underwent VSP-assisted orthognathic surgery between 2019 and 2025. Sagittal skeletal classification, vertical growth pattern, facial asymmetry, and maxillary crossbite were evaluated together with planned maxillary and mandibular movements. Surgical procedures were analyzed according to skeletal malocclusion classes (Class I, II, and III). Group comparisons were performed using chi-square and Kruskal–Wallis tests. Multivariable logistic regression analysis was conducted to assess factors associated with bimaxillary surgery (p < 0.05). Results: Skeletal Class I malocclusion was most prevalent (46.8%), followed by Class III (29.7%) and Class II (23.4%). Hyperdivergent growth patterns were predominantly observed in Class II patients, whereas normodivergent patterns were most common in Class III cases (p < 0.05). Mandibular advancement and setback generally followed expected class-based trends but were also observed across non-corresponding skeletal classes. Maxillary impaction and mandibular autorotation were frequently incorporated. Bimaxillary surgery was performed in 84.2% of cases. Logistic regression analysis showed no independent predictors of bimaxillary surgery (p > 0.05). Conclusions: VSP-assisted orthognathic surgery demonstrates that surgical planning cannot be reduced to sagittal skeletal classification alone. Treatment decisions are shaped by combined sagittal, vertical, transverse, and patient-specific factors, supporting a multidimensional and individualized planning approach. Full article

Background: The dynamic development of information technologies, particularly in the fields of computer image analysis and artificial intelligence (AI) algorithms, plays an increasingly important role in orthodontic diagnostics. Cephalometric images constitute a fundamental element in orthodontic treatment planning. They contain encoded information related to the assessment of craniofacial growth and development, which is the focus of algorithms employing machine learning and process automation. Objectives: The aim of this paper is to present the current state of knowledge regarding the application of artificial intelligence methods in cephalometric image analysis, with particular emphasis on studies published between 2020 and 2025 in the Scopus and Web of Science databases. Results: Twenty key studies were included. The most commonly used models were convolutional neural networks (CNN), You Only Look Once (YOLO), Bayesian convolutional neural networks (BCNN), artificial neural networks (ANN), stacked hourglass networks, and Deep Neural Patchworks (DNP). In landmark detection tasks, the average location errors ranged from 1 to 2 mm compared to expert annotations, remaining within clinically acceptable limits. YOLO- and CNN-based systems achieved accuracy comparable to that of experienced orthodontists, while BCNN models additionally provided uncertainty estimates that improved clinical interpretability. In classification tasks, artificial neural network (ANN) models assessing cervical vertebral maturity (CVM) achieved an accuracy of up to 95%. In screening studies prior to orthognathic surgery, a multilayer perceptron combined with a regional convolutional neural network achieved 96.3% agreement with expert decisions. Conclusions: AI-based tools provide clinically acceptable accuracy in cephalometric analysis, with landmark detection errors typically ranging from 1 to 2 mm compared to expert assessment. These systems improve repeatability and significantly reduce analysis time, especially when used in semi-automated workflows. AI-based assessment of cervical vertebral maturity and surgical eligibility shows high agreement with expert decisions, confirming their role as reliable tools to support clinical decision-making. Nevertheless, broader validation in different patient populations is necessary before routine clinical implementation. Full article

Background and Objectives: Combined orthodontic–orthognathic treatment is the standard approach for managing severe dentofacial deformities. Nevertheless, its potential impact on periodontal tissues, particularly gingival recession (GR), remains a matter of clinical concern. This study aimed to evaluate the relationship between orthodontic–orthognathic procedures and GR based on available clinical evidence, with particular focus on potential risk modifiers, including orthodontic mechanics, surgical factors, and periodontal phenotype. Materials and Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The review question was formulated using the PICO framework. Results: Seven observational clinical studies were included, with sample sizes ranging from 24 to 40 patients. GR outcomes varied considerably according to surgical procedure, orthodontic mechanics, adjunctive therapies, and patient-specific factors. Overall certainty of evidence was low–moderate. Conclusions: GR following combined orthodontic–orthognathic treatment is inconsistently reported and influenced by multiple clinical variables. Evidence suggesting roles for periodontal phenotype and adjunctive therapies, including PAOO, remains limited and context-dependent. Overall certainty of evidence is low–moderate, and findings should be interpreted cautiously. Full article

Facial profile esthetics play a pivotal role in orthodontic diagnoses, treatment planning, and patient satisfaction; however, the perception of facial attractiveness is inherently subjective and varies according to professional expertise and sociocultural background. This study aimed to compare the perceived attractiveness of standardized sagittal facial profiles across skeletal Class I, II, and III patterns and to investigate the influence of professional training and sociodemographic variables on facial profile evaluations. It was hypothesized that straight facial profiles would be perceived as the most attractive across all observer groups, while deviations from the orthognathic profile would be rated as less attractive, with significant differences based on professional training and sociodemographic variables. This cross-sectional descriptive study included 509 participants, comprising orthodontists, orthodontic Ph.D. students, general dentists, specialist dentists, first- and fifth-year dental students, and laypersons. Seven standardized sagittal facial profile silhouettes (S1–S7) were digitally generated from a standardized lateral facial photograph and evaluated using a seven-point visual analog scale. Participants were also asked to identify the sagittal facial profile range (S8) they ideally preferred to possess. Intergroup comparisons were performed using non-parametric statistical tests (Mann–Whitney U and Kruskal–Wallis). The straight profile (S3) emerged as the most attractive and most frequently preferred across all participant groups, confirming its role as the dominant esthetic reference. Retrusive profiles, particularly bimaxillary retrusion (S2), mandibular retrognathism (S5), and maxillary retrusion (S6), were consistently rated as the least attractive. Significant differences in esthetic perceptions were observed according to the professional expertise, educational level, age, and nationality, whereas gender had no clinically meaningful effect. Orthodontic training was associated with increasingly critical evaluations, especially for protrusive and convex profiles, while laypersons demonstrated greater esthetic tolerance. Both anatomical characteristics and sociocultural experience shape the perception of facial profile esthetics. While the straight profile represents a widely shared aesthetic ideal, increasing orthodontic expertise accentuates discrepancies between professional standards and public preferences. These findings underscore the necessity of integrating patient-centered and culturally sensitive considerations into contemporary orthodontic treatment planning. Full article