To characterize current lingual orthodontic (LO) practice among orthodontists in France, assess how the emergence of clear aligner (CA) therapy has influenced its clinical use and document clinicians' perspectives on the future of LO. A survey using a 39-item questionnaire was administered via the SurveyMonkey® platform. The survey was distributed through the French Syndicate of Specialists in Orthodontics (SFSO), the Syndicate of Orthodontists of France (Les ODF), and a professional Facebook group, reaching an estimated 2971 orthodontists. Responses were collected anonymously. Data were analyzed using Python v3.12.7 with univariate and bivariate statistics; associations were assessed using χ2 and Spearman correlation tests, with significance set at α = 0.05. Of 201 respondents, 59.7% (n = 120) reported active practice of LO. The most frequently used systems were WIN® (43.9%) and Incognito® (36.7%). A majority of practitioners treated 1-10 lingual cases annually, whereas aligner therapy was reported more frequently, with 28.3% indicating 21-50 aligner cases per year. Nearly half (48.4%, n = 46 of 95 respondents) reported offering lingual treatment less often since the rise in aligner use, and 76.8% (n = 73 of 95 respondents) perceived a decrease in patient demand for lingual appliances. Major reported barriers to lingual practice included prolonged chairside time (28.5%), limited clinician training (23.5%), and low patient demand (22.3%). Despite these challenges, 92.3% of respondents reported satisfaction with their clinical outcomes. Following the discontinuation of the Incognito® system, 28.6% of users planned to discontinue LO, and 80% expressed intent to transition to aligner therapy. Although a majority of the respondents report experience with LO, it represents a minority of their annual caseload. The increasing use of CAs appears to have influenced reported practice patterns. However, these findings reflect practitioner-reported behaviors and perceptions rather than clinical indications or appropriateness. LO is still perceived by clinicians as offering advantages in predictability, efficacy, and esthetic discretion, suggesting it may continue to play a role for select patients in contemporary orthodontic practice.
Artificial intelligence has been gaining popularity in all fields of dentistry. Orthodontic screening is needed to categorize patients for treatment eligibility and urgency of care in public orthodontic clinics. However, screening is time consuming due to high demand. This is the first study to investigate the use of artificial intelligence-supported teleorthodontics for orthodontic screening and triage. The objective of this study was to investigate the validity of teleorthodontics and artificial intelligence (TAI) in orthodontic screening and triage in comparison to face-to-face (F2F) screening. This study was designed as a single-centre crossover randomized controlled trial. A total of 255 patients referred for public orthodontic treatment were randomized into two sequences: control, F2F triage first, and test, TAI triage first. A total of 178 participants completed the trial (age range: 7-38 years) with 95 participants enrolled initially to the control and 83 to the test sequence, respectively. For TAI triage, patients submitted intraoral scans using Dental Monitoring™ (DM™), extraoral photos, and an online patient history survey. After a 2-month washout period, participants were re-triaged with the other method. The primary outcome was the validity of TAI triage in referral acceptance or rejection based on a minimum Index of Orthodontic Treatment Need (IOTN) Dental Health Component (DHC) threshold of ≥3. Secondary outcomes were diagnostic validity of TAI for all IOTN grades, at referral acceptance threshold IOTN ≥ 4, and triage duration comparison. Patients were randomized using a permuted randomized block design (allocation ratio 1:1). Investigators and participants could not be blinded to sequence allocation. Referral acceptance or rejection at IOTN ≥ 3, TAI triage had a sensitivity of 1, a specificity of 0.67, and an overall diagnostic accuracy of 0.98, with three referrals incorrectly rejected by TAI. Artificial intelligence could not detect OB and OJ correctly for some patients and did not measure important traits, including crossbite, contact point displacement, and functional shift. Teleorthodontic triage duration was 2.9 times faster than F2F. This study was conducted in a public orthodontic clinic, and results apply to this setting when using IOTN and the hybrid method used in this investigation. Teleorthodontics combined with DM™ is a valid and reliable tool for orthodontic screening of patients with mild and severe malocclusions but cannot be used to confidently assign IOTN-DHC grade for patients with borderline malocclusion severity yet. The duration of screening is significantly shorter using TAI. Australian New Zealand Clinical Trials Registry ID: ACTRN12623000327684.
To perform an authorship-focused bibliometric analysis of highly cited authors who published in the American Journal of Orthodontics and Dentofacial Orthopaedics (AJODO), Angle Orthodontist (AO), and European Journal of Orthodontics (EJO). Furthermore, to evaluate the effect of journal type on bibliometric indices, and identify predictors of total citations. A bibliometric analysis using Dimensions Analytics and Scopus (inception-April 2025) identified authors with > 100 citations who published in the AJODO, AO, and the EJO. Extracted data included author-level metrics (total citations, citations per document, publication count, h-index, field-weighted citation impact (FWCI), collaboration, number of coauthors) and regional and institutional information. Descriptive statistics, regression analysis, and variable importance analysis were performed. Authors with > 100 citations were common in AO (n = 230), followed by AJODO (n = 133) and EJO (n = 68). Compared with AJODO, authors publishing in AO and EJO had significantly lower total citations (incidence rate ratio (IRR) 0.52 and 0.57, p < 0.001), citations per document (0.52 and 0.54, p < 0.001), number of publications (0.47 and 0.51, p < 0.001), h-index (coefficients -15 and -18, p < 0.001), and number of coauthors (IRR 0.38 and 0.46, p < 0.001). No significant differences were observed between journals for collaboration or FWCI. Citations by documents and h-index were the strongest predictors of citation counts. Although most highly cited authors were from AO, AJODO authors had higher citations, publications, and h-index. Authorial influence is multidimensional, and robust evaluation requires a combination of citation metrics, productivity measures, and context-specific assessments.
This study aimed to evaluate the adequacy of reporting and the accuracy of sample size calculations, with particular emphasis on standard deviation (SD) assumptions, in randomized controlled trials (RCTs) published in 5 leading orthodontic journals in 2021 and 2022. This meta-epidemiologic study included RCTs involving human participants from the European Journal of Orthodontics, The Angle Orthodontist, Progress in Orthodontics, American Journal of Orthodontics and Dentofacial Orthopedics, and Orthodontics and Craniofacial Research. We assessed the reporting of essential parameters for sample size calculation, including significance level (α), power (1-β), effect size, and SD. For studies with sufficient data, we recalculated sample sizes and analyzed discrepancies between assumed and recalculated values. We also compared assumed vs observed SDs and explored associations with study characteristics using descriptive statistics and regression analyses. Of the 107 included RCTs, 62.1% of trials with continuous outcomes provided all essential parameters (41.6% for dichotomous/time-to-event outcomes). Recalculation was feasible in 77.6% of trials. Overall, the assumed sample sizes were generally smaller than the recalculated values, with approximately 55% of studies underestimating the required sample size and approximately 30% showing discrepancies greater than 10%. In addition, around two-thirds of the comparable studies showed differences of more than 30% between the assumed and observed SDs. The findings suggest that the reporting and accuracy of sample size calculations in orthodontic RCTs could be further improved. Greater emphasis on transparent reporting, adherence to established guidelines such as Consolidated Standards of Reporting Trials (CONSORT), and appropriate statistical support may contribute to strengthening the quality of orthodontic clinical research.
The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.
Maternal nutrition is increasingly recognized as a modulator of offspring skeletal development. While genetics has long been considered the primary determinant of craniofacial morphology, emerging evidence suggests that prenatal and early postnatal dietary exposures also influence facial morphology. However, how maternal diet differentially affects male and female craniofacial structures remains unclear. This study aimed to examine the effects of a maternal high-fat, high-sugar (HFHS) diet on craniofacial and dental morphology in first- (F1) and second- (F2) generation adult mice. Female mice were fed a HFHS diet for 6 weeks before mating and throughout pregnancy and lactation. F1 offspring were weaned to a standard chow diet, and a subset of female F1 offspring were bred to produce F2 offspring, also maintained on chow. Craniofacial skeletal and dental structures of adult F1 and F2 mice at 1-year of age were assessed using micro-computed tomography for linear and geometric morphometrics. HFHS diet exposure significantly reduced midfacial and mandibular length in F1 females, and these effects persisted in F2 females. In males, cranial and mandibular morphology were not affected. Tooth size was reduced in both sexes of F1 offspring but not in F2. Maternal HFHS diet induces jaw-specific changes in offspring craniofacial morphology, with subtle skeletal differences observed in females across both generations. By contrast, dental effects did not persist beyond one generation. These findings highlight the potential for maternal dietary habits to exert both immediate and transgenerational influences on offspring facial form that may persist into adulthood.
To examine the profile of funded orthodontic articles and compare the citation impact and online visibility of grant-supported versus unfunded publications. All orthodontic articles published in 2021 that included funding acknowledgments were retrieved through a systematic search of the Web of Science (WoS) Core Collection. Article, authorship collaboration and funding characteristics were analysed using negative binomial regression to evaluate their association with the number of WoS citations. Altmetric Attention Scores (AASs) and citations for a subsample of funded articles were compared with those of unfunded articles published in the same journals to assess the impact of funding. A total of 484 publications were identified, with a median of 6 authors [interquartile range (IQR): 4], 3 institutions (IQR: 3), and 8 WoS citations (IQR: 10). More than half of the articles originated from Asia, and nearly one-fourth were published in journals issued by publishers once claimed as predatory. National collaboration, extramural funding, and national public funders accounted for the greatest proportion of publications. The number of collaborating countries and PubMed indexing were significantly associated with more citations (P < 0.05), while free article availability and author origin showed weaker associations (P = 0.05 and P = 0.06, respectively). Unfunded publications appeared to receive significantly higher citation counts and AASs compared with funded ones. The number of collaborating countries and PubMed indexing were significantly associated with a higher citation impact among grant-supported orthodontic articles. Funding did not appear to significantly influence citation numbers or online attention. The substantial involvement of formerly flagged predatory publishers in the publication of funded orthodontic studies could prompt ethical concerns.
While current evidence suggests that dentofacial orthopaedic treatment neither increases nor decreases TMD signs and symptoms, corresponding data on treatment performed in adults are lacking. Therefore, the objective of this study was to assess the long-term (≥15 years) prevalence of signs and symptoms of TMD in adult Class II Herbst-multibracket appliance (MBA) patients including oral health related quality of life. All patients (Department of Orthodontics, University of Giessen, Germany) in which Herbst-MBA treatment had been performed during adulthood and ended ≥15 years ago, that could be contacted and were willing to participate. Records from before (T0) and after active treatment (T1) were compared with the recall data (T2). The DC/TMD and the Helkimo index were used for TMJ analysis. In addition, the participants filled out the oral health impact profile (OHIP) questionnaire 14 at T2. 31 out of 51 patients with an average age at recall of 43.4 ± 7.4 years participated. The prevalence of patients free of TMD signs and symptoms (DC/TMD) was 50% (T0), 84% (T1), 75% (T2). The corresponding reduction in TMD prevalence went along with a decrease in TMD severity both anamnestically and clinically (Helkimo Index). Overall, signs and symptoms fluctuated and there was a trend towards improvement (T0-T1) and recurrence (T1-T2). None of the changes was statistically significant. The level of oral health related quality of life was very high (OHIP: median = 1). Adult Herbst-MBA Class II treatment does not seem to be associated with a clear trend regarding incidence/prevalence of TMD in the long-term (≥15 years). WHO ID: DRKS00023022.
The use of clear aligners (CA) has exponentially increased in the last decades due to their superior esthetic, ease of use and cleaning, and comfort in comparison to conventional fixed appliance (FA). However, prolonged wearing of CA could also alter oral microbiome and adversely affect oral hygiene and periodontal health. To assess oral hygiene level and periodontal health status in patients treated with CA versus those treated with FA using a combination of risk of bias (RoB) and Grading of Recommendations Assessment, Development and Evaluation (GRADE) tools. A comprehensive electronic search was conducted in four databases, including Scopus, PubMed, Web of Science, and Google Scholar, to retrieve relevant randomized controlled trials (RCTs) in the last 10 years from 2015 to April 2025. The study aimed to include RCTs that focused on the impact of CA and FA orthodontic treatments on oral hygiene and periodontal health. Independent eligibility assessment, data extraction, and filtering process were performed. The RoB 2 tool was used to assess the quality of the included RCTs. Data relating to oral hygiene/periodontal health assessed by different clinical periodontal indices (primary outcome) and other findings (secondary outcomes) were extracted. Certainty of evidence was determined using GRADE system. Initial search process yielded 1098 records which were assessed for eligibility, screened according to titles, abstracts, and full-text reading. Six RCTs were found eligible for analysis and included for synthesis of evidence. Qualitative analyses of the included RCTs showed that periodontal parameters were significantly better in patients treated with CA than with FA. Five RCTs exhibited high RoB together with overall inconsistencies in the given oral hygiene instructions, age, follow-up, diagnosis, and measurements. Certainty of evidence ranged from very low for oral hygiene level and low for periodontal health. Dual quality assessment indicated that the advantages of CA over FA in terms of oral hygiene and periodontal health are highly compliance dependent. However, due to heterogeneities, high RoB, and low to very low certainty of evidence in current RCTs, outlining a firm conclusion was impeded. PROSPERO (CRD420251120933).
To compare treatment duration between self-ligating and conventional brackets, determine factors influencing treatment duration and compare the quality of orthodontic care with both bracket systems in a bimaxillary protrusion population. Participants were randomly allocated into the Smart Clip™ self-ligation bracket group or the Victory Series™ conventional ligation bracket group, both with MBT prescription (3M-Unitek, Monrovia, California, USA). Both extraction and nonextraction cases were included. Primary outcome measures included (i) overall treatment duration, (ii) levelling and aligning duration, (iii) Space closure and finishing duration, and (iv) number of appointments and other treatment related factors. The secondary outcomes assessed the quality of care. These occlusal outcomes included incisor inclination, ABO CR-EVAL, patient perception using the Index of Treatment Need and three validated questionnaires before, during and after treatment, measuring patient satisfaction with treatment and patient experience. Independent sample t-test and chi-square tests were conducted to assess differences in groups. Descriptive statistics and parametric tests were conducted. Also, nonparametric tests were carried out where appropriate. This clinical trial was ongoing during the COVID-19 pandemic, therefore, the effect of the pandemic on the trial was also assessed. A total of 109 participants were enrolled. They were randomized in a 1:1 ratio; 13 were excluded (poor attendance prior to and poor attendance due to the COVID-19 pandemic). Forty-nine participants were analysed in the conventional bracket group and 47 in the self-ligating group. The overall mean age was 13 years. The groups were similar pre-treatment, and no statistical significance was found between the groups for treatment duration, duration of key stages and number of appointments (P > 0.05). The mean duration of treatment was 24.34 months for the conventional bracket group and 25.83 months for the self-ligating bracket group. ABO CR-EVAL showed a better quality of finish in the self-ligating bracket group. This, however, was not significant statistically. In both the conventional and self-ligating groups, the post-treatment U1-PP and L1-MP angles were consistent with the reported norms for this population. In extraction and nonextraction cases the self-ligating bracket retroclined the upper (9.2°in extraction and 2.2°in nonextraction cases) and lower incisors (7.3° in extraction and 3.9° in nonextraction cases) more than conventional bracket. In nonextraction cases these differences were not statistically significant (P > 0.05). Pre to post-treatment, there was a highly statistically significant improvement in the IOTN aesthetic component in both groups (P < 0.01).There was a significant difference between groups for pre-IOTN aesthetic assessment. The COVID-19 pandemic had no statistically significant impact on the overall treatment duration. However, it did have an effect on the collection and analysis of some data, with no overall effect on the majority of outcomes assessed in the trial. It was not possible to blind the operator or participants to the allocation. Use of Smart Clip™ self-ligating bracket does not reduce overall treatment time in bimaxillary protrusive patients. There were fewer total visits in the self-ligating bracket group when compared with the conventionally ligated bracket group. There is no evidence to suggest a difference in the quality of care or patient experience between self-ligating and conventional bracket systems in a bimaxillary protrusive population. The COVID-19 pandemic did not affect treatment duration. The trial was registered with ClinicalTrials.gov on 26th June 2019. Registration number NCT04001816. The protocol was not published before trial commencement. The trial was funded by grants from The University ofThe West Indies ( CRP.3.MAR14.3, CRP.3.MAR14.3(1), CRP.3.MAR 14.3(4))andproduct donations from 3M Unitek.
To compare orofacial dysfunctions (OFD) in individuals with rare diseases, with and without open bite (OB) malocclusion, and to explore the associated symptoms. In total, data for 788 individuals representing 164 different rare diseases, were collected from the MHC database for the period of 2013-2019. The inclusion criteria were having a rare disease and having completed the Nordic Orofacial Test-Screening (NOT-S). OB was categorized as anterior OB (AOB), lateral OB (LOB), and severe anterior OB (AOBS). The sample was divided into two groups: 142 with OB (mean age, 14.2 ± 13.0 years; 81 males, 61 females); and 557 with normal vertical relation (NVR) (mean age, 15.1 ± 12.9 years; 292 males, 265 females). OFD was compared between the groups. Items from the NOT-S test were analysed, and the Odds Ratio (OR) for OB was calculated. The OB prevalence was 18%, with AOB being the most-common sub-type (58%), followed by AOBS (15%) and LOB (13%). Nemaline myopathy was the disease with the highest prevalence rates for OB and AOBS. The OB group had a larger proportion of OFD than the NVR group in 6/12 domains of the NOT-S. Deviant tongue posture was most strongly associated with OB (OR 6.062). Two-thirds of the individuals had OFD, and OB was a common finding (18%). Rare diseases with symptoms of orofacial hypotonia, craniofacial abnormalities and macroglossia show a higher prevalence of OB. A deviant tongue posture showed the highest odds for OB in this group of rare diseases.
Malocclusions occur at high frequencies in children and adolescents. While early orthodontic (interceptive) interventions may reduce the need for later comprehensive treatment, their cost-effectiveness in publicly funded health systems is unclear. This study compares the cost-effectiveness of interceptive orthodontic care and fixed-appliance therapy, focusing on total costs, treatment outcomes, and resource use. A decision tree model was developed using observational data on treatment success rates, duration, and appointments to estimate resource use and costs for interceptive orthodontic care; Fixed Appliance therapy was modeled as an optimal 2-year treatment pathway. A health-care payer perspective was applied. Incremental costs and effects were calculated for four interceptive modalities: Quad Helix, Extraoral Traction (EOT), Removable Plates, and Activator appliances, as compared to fixed appliance therapy. Minimum required success rates were estimated for achieving cost-neutrality. Probabilistic sensitivity analyses (10 000 Monte Carlo simulations) and scenario analyses assessed the robustness of the results. All the interceptive treatments demonstrated lower expected costs than the fixed appliance therapy, albeit with lower clinical effectiveness. Quad Helix exceeded the minimum required success rate 20% points, representing a clear margin of cost-effectiveness. Removable Plates also exceeded the minimum required success rate, but with a smaller margin of 6% points. The Activator and EOT appliances were more dependent on patient compliance and failed to meet the minimum required success rate, requiring increases of 13% and 10% points, respectively, to achieve cost-neutrality. Sensitivity analyses confirmed these patterns and underscored the importance of long-term treatment stability. The model assumed a 100% success rate for fixed appliances and relied on expert opinion for long-term stability parameters, given the limited availability of relapse data. In the publicly funded dental care context studied, the use of Quad Helix and removable plates in publicly funded health-care systems appears to be cost-effective. Activator and EOT appliances should be used selectively. The study also contributes a transparent, adaptable modeling framework that can incorporate locally relevant costs and future long-term outcome data, supporting use in other publicly funded settings.
Tooth segmentation remains the most time-consuming task during model preparation for digital orthodontic setup. This study aimed to assess the accuracy of AI-based tooth segmentation tools of four widely used orthodontic platforms, namely Medit LINK (©Medit Corp, South Korea), DentOne (©DIORCO Co, South Korea), BlueSkyPlan (Blu Sky Bio, USA), and ArchForm, using models categorized by specific clinical characteristics. A total of 270 digital dental models were retrospectively selected and assigned to nine groups: aligned dentition, crowding, spacing, ectopia, agenesis, gingival recession, tooth wear, orthodontic brackets, and attachments. Automated labeling success and segmentation quality were evaluated for each software. Mesio-distal (MD) tooth widths were calculated using Meshmixer software (Autodesk, San Rafael, Calif) and compared with unsegmented models (ground truth). All data were statistically analyzed. BlueSkyPlan consistently outperformed the other tested software in tooth labeling, surface segmentation, and mesio-distal measurements accuracy across all model groups (P < 0.05). Labeling errors were most frequent in models with ectopic teeth (≤12.2% success) and agenesis (≤53.1% success). Surface-specific errors increased with crowding (buccal/lingual errors), spacing (mesio-distal errors), gingival recession (buccal errors), and tooth wear (occlusal errors). All software overestimated MD widths compared with ground truth with the limits of agreement considered clinically relevant (>0.30 mm) in specific software-model combinations). The software evaluated does not provide transparency regarding the AI technologies implemented. The accuracy of automatic segmentation of intra-oral scans is influenced by clinical and anatomical characteristics of the dental arches and still requires clinician supervision. BlueSkyPlan currently appears to provide the most reliable performance among the tested platforms.
Early treatment of malocclusion in primary and early mixed dentition is often carried out by dentists under the supervision of orthodontists. In these treatments, simple appliances are preferred. To analyse which occlusal traits can be corrected with prefabricated eruption guidance appliances (EGAs) in mixed dentitions. Articles written in English and published between January 1990 and March 2023 were searched from Cochrane Library, Clinicaltrials.gov, EMBASE, International Clinical Trials Registry Platform, LILAC, PubMed, and Scopus. The inclusion criteria were formed according to the Patient, Intervention, Comparison, Outcomes, and Study design schema (PICOS). Selection of the articles followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk of bias was evaluated using RoB 2 and ROBINS-I tools. The pooled estimates for the change in clinical and cephalometric measurements were calculated. The overall quality of the outcome was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Seven articles with 277 patients and 219 controls were included. One was a randomized controlled trial, one was a retrospective study, and three were prospective treatment studies. Two follow-up studies analysed cephalometric data of already included studies. Four prefabricated appliances were used: Education Fonctionnelle, LM-Activator™, Nite-Guide®, and Occlus-o-Guide®. Treatment protocols varied from passive night-time use to combinations of active daytime and passive night-time use. Treatment periods varied from 10 months to 3.3 years. The main findings were reductions in overjet (range 1.1-2.3 mm) and overbite (range 0.6-2.0 mm). Other findings included improvement in crowding and molar relationship and better tooth-to-tooth contacts. Even though most of the changes were dental, significant increases in the length of the mandible were reported in two studies. Four studies were included in the meta-analyses. In these analyses, the changes in overjet, overbite, SNB, and ANB were found statistically significant. EGAs comprise a group of functional appliances suitable for reduction of excessive overjet and overbite in mixed dentition. However, more studies are needed to elucidate their effects on skeletal structures. The protocol for this review was registered at PROSPERO under the ID CRD42023441197.
Class II malocclusion is primarily caused by mandibular retrusion and has significant functional, aesthetic, and psychological implications. Although there are many non-surgical treatment options available, their actual skeletal effects are still mild, varied, and not always reported. Clear conclusions have been limited by overlapping data and variable quality, despite these interventions being the subject of numerous systematic reviews (SRs). To synthesize and critically appraise evidence from published SRs of the efficacy of orthodontic and dentofacial orthopaedic interventions for skeletal Class II malocclusion. PubMed, Scopus, Embase and Google Scholar were systematically searched till May 2025. A manual citation search was also performed. SRs involving children or adolescents with clinically and/or radiographically confirmed sagittal skeletal discrepancies, assessing non-surgical interventions against any comparator, and evaluating outcomes including skeletal changes, patient-reported measures, or operator-related measures, using qualitative, quantitative, or mixed synthesis, without restrictions on language or publication year, were included. Two independent reviewers selected the included reviews, initially by screening titles and abstracts, and then by reading the full texts. Methodological quality was evaluated using the AMSTAR-2, and the risk of bias was assessed using the ROBIS. Overlap of primary studies was quantified using the GROOVE tool. When second-order meta-analysis (meta-meta-analysis or MMA) was feasible, random-effects models were used; otherwise, narrative synthesis was performed. The certainty of evidence was rated using the GRADE method. Twenty-eight SRs were included. The most consistent skeletal improvements, particularly in ANB and SNB angles and mandibular length, were shown by removable functional appliances (RFAs), especially the Twin Block. Fixed functional appliances produced favourable but more variable effects, while headgear reduced maxillary growth but was compliance-dependent. Incremental mandibular advancement offered little advantage over single-step protocols, and no clear benefit was observed for early versus late treatment. Considerable heterogeneity and overlap across reviews limit confidence in pooled estimates. RFAs show the most consistent direction of skeletal improvement, although the magnitude of change is modest and the certainty of evidence is predominantly low. Findings for other approaches remain inconsistent and methodologically limited. Future research must incorporate standardized protocols, age-stratified outcomes, and patient-centred measures through rigorously designed randomized controlled trials to strengthen clinical guidance. PROSPERO: CRD42024565809.
Orthodontic tooth movement (OTM) is a dynamic biological process driven by mechanically induced tissue remodeling. The transcriptional regulators, particularly the noncoding RNAs in human tissues remains limited. This study employs RNA sequencing and bioinformatics to analyze the transcriptomic profile at day 7 of OTM, and to identify potential regulatory factors associated with mechanical stimulus. RNA sequencing was performed on human periodontal ligament tissues obtained from extracted first premolars of OTM and non-OTM (control) patients (n = 3 per group) after seven days of orthodontic force application. Differentially expressed mRNAs, lncRNAs, and circRNAs were identified, followed by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses. Competing endogenous RNAs (ceRNA) networks and a mechanical stimulus-related circRNA-miRNA-mRNA network were constructed using bioinformatic approaches. qRT-PCR was applied for validation in an independent set of samples (n = 5 per group). Compared with control group, a total of 337 mRNAs, 687 lncRNAs, and 377 circRNAs were significantly up-regulated in human periodontal ligament tissues of the OTM group. Conversely, 341 mRNAs, 1253 lncRNAs, and 109 circRNAs exhibited down-regulated expression during OTM. GO and KEGG analyses highlighted key biological functions and signaling pathways involved in bone modeling, with significant enrichment of inflammatory and immune-effector pathways. A predicted lncRNA/circRNA-miRNA-mRNA network active during OTM was constructed, and the circELP3-hsa-miR-629-3p/hsa-miR-29b-2-5p-TLR7/ITGAM axis was identified as potential regulatory pathway related to mechanical stimulus. This finding was subsequently validated by qRT-PCR. mRNAs, lncRNAs, and circRNAs in human periodontal tissues are differentially expressed at day 7 of OTM, and form a complex ceRNA network. The circELP3-hsa-miR-629-3p/hsa-miR-29b-2-5p-TLR7/ITGAM axis might be involved in mechanical stimulus of OTM at day 7. These findings provide insights and molecular clues that could inform future strategies for modulating bone remodeling in periodontal tissues during orthodontic treatment.
This systematic review aims to evaluate the clinical applicability of automated 3D facial asymmetry assessment methods based on 3D facial scans. A comprehensive search of electronic databases (PubMed, Web of Science, EMBASE, Medline, and Scopus) and manual literature searches were conducted in April 2025. Studies that were published in English and evaluated the validity or reliability of automated asymmetry assessment methods in 3D facial scans for medical or biological settings were included. Two reviewers independently screened the articles for eligibility. Risk of bias was assessed using QUADAS-2, and the certainty of evidence was graded using the Grading of Recommendations Assessment, Development, and Evaluation framework. Fourteen studies met the inclusion criteria and were analyzed for methodology, validity, and reliability. Methodologies for assessing facial asymmetry were categorized into four approaches: landmark-based, depth-stratified, original-mirror alignment, and template-based approaches. While landmark and depth-stratified methods rely on sparse data, original-mirror and template-based methods enable comprehensive surface analysis. Six studies evaluating validity against alternative methods, synthetic ground truth, or human ratings consistently demonstrated moderate-to-strong correlation coefficients and classification accuracy. Reliability was examined across nine studies using repeated measurements and multi-observer designs, generally showing minimal measurement variation. Notably, methodological analysis revealed that original-mirror alignment, typically implemented using unconstrained iterative closest point (ICP)-based best-fit registration, is susceptible to registration errors (the "Pinocchio effect") in cases of severe asymmetry, whereas template-based methods mitigate this through correspondence transfer and weighted registration strategies that stabilize anatomical alignment. The review is limited by a high risk of bias in primary studies and significant methodological heterogeneity. Despite "very low" certainty evidence, template-based approaches that transfer anatomical correspondence and apply weighted registration appear preferable due to their robustness against localized deformities. Conversely, original-mirror alignment, typically implemented via unconstrained ICP, remains a practical alternative for mild asymmetry. Future research should prioritize end-to-end deep learning automation, dynamic analysis, and the development of accessible, open-source tools to bridge the gap between technical innovation and routine clinical practice. PROSPERO (CRD420251025105).
White spot lesions (WSLs) are a common clinical finding with implications for both individuals and society. Several treatment approaches have been proposed, among which resin infiltration (RI) has emerged as a promising option. Investigate clinical and patient-reported outcomes of RI on WSLs at different time points. Unrestricted literature searches were conducted in six databases for human studies until September 2025. Randomized and non-randomized clinical studies on patients with WSLs on at least one anterior tooth treated with RI assessing different clinical- and patient-reported outcomes with a minimum patient follow-up of 3 months. Study selection, data extraction, and risk of bias assessment were performed in duplicate. Random-effects meta-analyses of pooled average changes between post-treatment and follow-up time points with their corresponding 95% confidence interval (CI) were performed, followed by sensitivity analyses. Thirty-four reports pertaining to 29 studies were included covering 544 patients (ages 7-40 years; 44% male on average) and 1495 teeth with WSLs. The risk of bias assessment revealed concerns mainly due to the small sample sizes, short follow-up periods, absence of blinded measurements, and lack of analysis of confounding factors or within-patient clustering. For most outcomes, RI showed inconsistent and heterogeneous effects. In the largest meta-analysis (six studies) comparing the standardized color difference (ΔE) between WSL and sound adjacent enamel from post-treatment to 6 months, the pooled average change was 0 (95% CI -0.42 to 0.41; P = .98), with high heterogeneity (I2 = 84%). A small meta-analysis showed significant improvements in patient satisfaction through a Visual Analogue Scale from post-treatment to 1 month (two studies; +11.9 mm; 95% CI +5.9 to +17.8 mm; P = .02), which diminished to non-significant levels at the 3 (P = .09), 6 (P = .20) and 12 months (P = .94). Twelve months post-treatment, no significant differences were seen for ΔΕ, fluorescence, patient satisfaction, or WSL area (P > .05). Among the included studies, high between-study heterogeneity was observed for most outcome measures, while most studies featured small sample sizes and short follow-up times. RI for WSLs shows highly inconsistent effects, compounded by limited follow-ups, highlighting the need for larger and standardized studies with extended follow-up to better evaluate treatment outcomes of resin-infiltrated WSLs. PROSPERO CRD42024611702.
Dental crowding affects nearly half of European adolescents and can negatively impact oral health-related quality of life (OHRQoL), particularly emotional and social well-being dimensions. Orthodontic treatment aims to improve function, aesthetics, and psychosocial well-being, yet active treatment may temporarily impair OHRQoL due to pain, dietary restrictions, and oral hygiene challenges. Understanding how conditions affect patients requires both objective and subjective assessments, yet patient reported outcomes remain underreported in orthodontic research, especially when comparing treatment techniques. To evaluate and compare OHRQoL, treatment motivation, expectations, quality of care and attention, and satisfaction in adolescents with dental crowding treated with two fixed appliance systems without extractions, and to explore factors associated with satisfaction with treatment outcomes. Multicentre, two-arm, parallel-group, superiority randomized controlled trial, with pooled analyses of both treatment groups, sex-stratified comparisons, and analyses exploring associations. Adolescents (n = 132), 12-17 years, with dental crowding were randomized with 1:1 ratio using computer generated random permuted blocks, stratified by sex, to receive fixed appliance treatment without extractions with either a conventional bracket system (CB; Victory) or a passive self-ligating bracket system (PSLB; DamonQ) at four orthodontic clinics. Primary outcome was Child Perceptions Questionnaire 11-14 (CPQ) score change. Two items were omitted; sensitivity analysis confirmed minimal impact on results. Secondary outcomes were patient experience and satisfaction questionnaires (10-point scale) assessed before treatment (T0), post-alignment (T1), and post-treatment (T2). Because of the nature of the treatments, only assessors could be blinded. Both the CB (♀39, ♂31) and PSLB (♀34, ♂28) groups reported improved OHRQoL (median CPQ score change T0-T2 for total sample: 4.5; r = 0.37, P < .001) with minor intergroup differences. Oral symptoms and functional limitations worsened at T1 then improved by T2 (median change T0-T2 for each domain: 1, r = 0.23, 0.27, respectively, P < .001), whereas emotional and social well-being improved throughout treatment (median change T0-T2 for each domain: 1; r = 0.28, P < .001). Median scores were high for motivation (9) and overall satisfaction with treatment outcomes (≥9), and low for regretting having started treatment (1). Correlations between treatment expectations and satisfaction were observed (ρ = 0.330, P < .001). Minor harms expected during orthodontic treatment included plaque accumulation, chafing and gingivitis. This study indicates that fixed appliance treatment for dental crowding leads to improvements in OHRQoL, with temporary declines during treatment, and high patient satisfaction in the studied sample. Patients reported satisfaction with the changes achieved, dental appearance, and did not regret having started treatment. The results demonstrate possible benefits of treatment, patient-centred care, and support the use of patient reported outcomes in orthodontic practice. ClinicalTrials.gov (NCT05664282) 2022-11-24.
Meningitis remains the leading infectious cause of neurological disabilities globally, disproportionately affecting children younger than 5 years and populations in the African meningitis belt. Whereas previous global estimates focused on ten pathogen categories, this study presents the most comprehensive analysis to date, assessing the meningitis burden attributable to 17 causative pathogens based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework. GBD is a systematic, scientific effort aimed at quantifying the comparative magnitude of health loss caused by diseases, injuries, and risk factors across age groups, sexes, and geographical locations over time. We estimated meningitis mortality using the Cause of Death Ensemble model (CODEm) and morbidity using DisMod-MR 2.1, incorporating data from vital registration, verbal autopsy, surveillance, hospital data, and systematic reviews. Aetiology-specific estimates were generated with pathogen-linked case-fatality ratios and splined binomial regression models. Risk factor attribution was based on established risk-outcome pairs and population attributable fractions. In 2023, there were 259 000 (95% uncertainty interval 202 000-335 000) global deaths and 2·54 million (2·20-2·93) incident cases of meningitis. Children younger than 5 years accounted for more than a third of deaths (86 600 [53 300-149 000]). Streptococcus pneumoniae, Neisseria meningitidis, non-polio enteroviruses, and other viruses were the leading causes of death, while non-polio enteroviruses caused the most cases. The four WHO-defined preventable meningitis pathogens of interest (S pneumoniae, N meningitidis, Haemophilus influenzae, and Group B streptococcus) contributed to 98 700 deaths (77 000-127 000) and 594 000 cases (514 000-686 000). Low birthweight, short gestation, and household air pollution were the top risk factors for meningitis-related mortality. Although mortality and incidence have declined significantly since 1990, progress is insufficient to meet WHO 2030 targets. Despite marked progress in reducing bacterial meningitis via global vaccination campaigns, a substantial meningitis burden persists, attributable both to common pathogens such as S pneumoniae and N meningitidis and to emerging non-bacterial pathogens such as Candida spp and drug-resistant fungi. Achieving WHO goals will require sustained investment in surveillance, vaccination, maternal screening, and health-system strengthening, especially in high-burden settings. Gates Foundation, Wellcome Trust, and UK Department of Health and Social Care.