Digital twin technology (DTT) is an emerging concept in healthcare enabling real-time patient and process simulations and predictive analytics that enhance personalized treatment and clinical decision-making. Orthodontics, being a comprehensive subject involving technicalities associated with diagnosis and treatment planning, the specific role of DTT, remains underexplored. This gap presents a crucial opportunity to harness its power to create dynamic virtual models for truly personalized and data-driven care. The objective is to map the extent and type of evidence available on the applicability of DTT in orthodontics, including its advantages, challenges, implementation in clinical settings, and perspective trends. A review synthesis for relevant articles published between 2005 and April 2025 in the English language was conducted across electronic databases including PubMed, Scopus, Embase, and Web of Science. Studies meeting the predefined eligibility criteria were included, and data relating to the applicability of digital twins (DTs) in orthodontics were assessed. To identify trends and inconsistencies in the existing literature, data extraction and synthesis of the findings were performed following the Joanna Briggs Institute (JBI) methodology. This scoping review has collated a consolidated view of research investigating the applicability of the DTs in orthodontics specifically. Nine studies were identified that mapped applications of this technology in orthodontics, which are currently limited yet diverse, ranging from static craniofacial twins built from cone beam computed tomography (CBCT) to multimodal ones combining CBCT, intraoral scanner (IOS), and facial scans for more detailed analysis. The elaborate theoretical foundation available for this technology in other sectors has the potential to be executed in orthodontics to revolutionize the field. DTT exhibits immense potential and clinical significance in the field of orthodontics and dentofacial orthopedics in the nearing future to ultimately enhance the accuracy and efficiency of diagnosis and treatment like never before, improving overall experience for the clinicians, students, and the patients.
Accelerated orthodontics seeks to reduce the prolonged duration of conventional orthodontic treatment and the associated pain and discomfort, particularly among adult patients. A growing body of invasive, minimally invasive, and noninvasive techniques, ranging from corticotomy and periodontally accelerated osteogenic orthodontics to piezocision, micro-osteoperforations, and low-level laser therapy (LLLT), has stimulated regional research activity and prompted the need to map scholarly output and trends across the Middle East. The objective of this work was to perform a comprehensive bibliometric analysis of accelerated orthodontics publications originating from Middle Eastern countries (2008-2025), identifying publication trends, leading authors and institutions, dominant research themes, citation impact, and patterns of regional collaboration to inform future clinical research priorities. A systematic search of PubMed, Scopus, and Web of Science was conducted in September 2025 using a predefined strategy. The PICOS criteria included adult patients (≥18 years) receiving fixed or removable orthodontic treatment with adjunctive acceleration methods; comparators were conventional treatment without acceleration; outcomes were treatment duration or rate of tooth movement; and eligible study designs were randomized controlled trials, cohort studies, and systematic reviews published in English between 2005 and 2025. Search results from the three databases were exported to EndNote and analyzed with the VOSviewer software (version 1.6.20) to generate co-authorship, co-citation, and keyword networks. Two independent reviewers screened titles/abstracts and full texts, with a third reviewer resolving discrepancies. Extracted bibliometric indicators included publication counts, citation totals, author and institutional affiliations, article types, and keyword clusters. Following the predefined search strategy, a total of 973 articles were initially identified and screened for relevance. After this screening process, 65 publications were included in the final analysis. The final corpus comprised 48 randomized controlled trials (76%), 16 systematic reviews (23%), and one cohort study (1%). Annual output and citations rose markedly from 2013 onward, with an exponential surge between 2021 and 2024 and a peak in 2022 (19 articles; 320 citations). A total of 120 authors contributed; the most prolific authors were Hajeer MY, Burhan AS, and Ajaj MA, with 14 of the top 15 authors affiliated with Syria. Damascus University produced 52 publications, and Syria led citation impact (1,772 citations), followed by Turkey and Saudi Arabia. Keyword analysis revealed four thematic clusters: pain and discomfort, acceleration methods (surgical, minimally invasive, and noninvasive), target populations, and gender. The most cited works focused on surgical approaches and LLLT. Accelerated orthodontics research from the Middle East has grown substantially, driven predominantly by Syrian institutions, especially Damascus University, and concentrated author networks. Surgical techniques and LLLT dominate high-impact publications, while minimally invasive and noninvasive modalities are increasingly investigated and appear more acceptable to certain patient groups. Broader multicenter and international trials, standardized outcome measures, and patient-centered evaluations are recommended to translate regional advances into generalizable clinical guidelines.
This study analyzed the publication characteristics, citation patterns, and research trends of the Turkish Journal of Orthodontics (TJO) since its Web of Science (WoS) indexing in 2017. A retrospective bibliometric analysis was conducted using data from the WoS Core Collection (2018-24) on April, 2025. Network analysis was performed using CiteSpace 6.3.R1 and VOSviewer 1.6.18. Descriptive statistics were used to analyze publication trends, authorship patterns, geographical distribution, and citation performance. A total of 244 publications were analyzed, comprising 192 (78.7%) original articles, 27 (11.1%) reviews, eight (3.3%) systematic reviews, and 17 (7.0%) case reports. The journal achieved an h-index of 15, with 1408 total citations and an average of 5.77 citations per article. Türkiye contributed the most publications (58.2%), followed by India (16.8%), the USA (6.6%), and Iran (5.3%). International collaboration involved 39 countries, and the most-cited article received 32 citations. The gender distribution of authorship was closely balanced: 52.2% female and 47.8% male. 94.7% of publications were multi-authored, with an average of 3.5 authors per article. Keyword analysis revealed thematic clusters dominated by clear aligners, malocclusion, cone-beam computed tomography, and dental materials. TJO shows consistent growth in publication volume, expansion of international collaboration, and increases in citation impact since WoS indexing. The journal successfully captures emerging trends in clear aligners and rapid maxillary expansion while maintaining coverage of fundamental orthodontic topics. A strategic editorial evolution toward systematic reviews indicates a commitment to evidencebased practice. This bibliometric overview offers a data-driven foundation for future editorial decision-making and monitoring the journal's evolving role within orthodontic research.
Tactile feedback through haptic technology is increasingly being applied in orthodontic education and selected clinical workflows, but its overall effectiveness has not been comprehensively synthesized. This systematic review and meta-analysis aimed to summarize the evidence on haptic and virtual reality technologies in orthodontic training and practice. In accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, a systematic search of multiple databases was conducted from inception through October 2025. Nine studies met the Population, Intervention, Comparison, and Outcome-based eligibility criteria. A random-effects meta-analysis was performed to estimate effect sizes (Hedges' g), and subgroup analyses were undertaken to explore heterogeneity. The pooled effect size was large and statistically significant (g = 1.40, 95% CI: 0.82-1.98, p < 0.001), although heterogeneity was high (I2 = 77.32). A subgroup analysis indicated beneficial effects in both bracket-bonding training and orthognathic surgical planning, with greater variability in bracket-bonding studies. Although the evidence base is limited by moderate risk of bias in several studies and a small number of trials, haptic and VR systems appear valuable for improving psychomotor learning and procedural planning in orthodontics. Their educational efficacy is supported, whereas translation to direct patient-care benefits remains promising but not yet firmly established. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251246154, PROSPERO 2025 CRD420251246154.
In situations where orthodontic tooth movement is expected to exceed the preexisting alveolar envelope, surgically facilitated orthodontic therapy (SFOT) has been advocated to expand the alveolar housing and reduce periodontal risks. However, detailed descriptions of soft-tissue management during SFOT remain limited. This technical note describes a surgical protocol incorporating a coronally advanced flap (CAF) within a segmental SFOT approach and illustrates its clinical application in patients undergoing orthodontic treatment requiring simultaneous periodontal phenotype modification. The proposed CAF-assisted SFOT protocol is based on three main principles: limiting the surgical intervention to the orthodontically involved segment, applying established mucogingival surgical principles to ensure predictable flap management, and using an acellular dermal matrix to contribute to both graft containment and soft-tissue thickening. The described technique provides a structured approach for integrating soft-tissue management into SFOT procedures and may facilitate simultaneous hard- and soft-tissue augmentation in orthodontic patients requiring phenotype modification. This case provides new information as it is, to the best of our knowledge, the first technical report describing the application of coronally advanced flap principles within a segmental surgically facilitated orthodontic therapy protocol. Successful management of this case relies on accurate interdisciplinary orthodontic-periodontal diagnosis, careful treatment planning, and appropriate flap management to ensure tension-free coronal advancement and graft stabilization. The primary limitation of this report is the absence of prospective clinical studies evaluating the long-term outcomes of this technique. Orthodontic treatment sometimes requires moving teeth beyond the natural limits of the surrounding bone, which can increase the risk of gum recession and other periodontal problems. Surgically facilitated orthodontic therapy (SFOT) has been introduced to expand the supporting bone and make such movements safer, but there is limited information on how to manage the gums during these procedures. This report describes a surgical approach that combines SFOT with a commonly used gum surgery technique called a coronally advanced flap. The procedure focuses only on the area where teeth are being moved, applies well-established principles of gum surgery to ensure stable healing, and uses a soft-tissue substitute to help protect the graft and thicken the gums. This technique offers a structured way to address both bone and gum deficiencies at the same time during orthodontic treatment. While promising, further clinical studies are needed to confirm its long-term effectiveness.
Sleep-Disordered Breathing (SDB) encompasses a spectrum of conditions ranging from primary snoring to obstructive sleep apnea (OSA), a condition linked to significant cardiovascular, metabolic, and neurocognitive risks. Dentists are in a strategic position to identify SDB early, yet international studies highlight insufficient curricular coverage. In Brazil, little is known about how undergraduate dental programs incorporate SDB-related education. A nationwide cross-sectional study was conducted among the 238 Brazilian dental schools that participated in the 2019 National Student Performance Exam (ENADE). Two self-administered digital questionnaires were distributed: one to course coordinators and another to orthodontics professors. Data were collected from March to October 2022. Descriptive analyses were performed to assess curricular inclusion, workload, faculty training, perceived importance, and barriers to SDB education. A total of 120 coordinators (response rate of 51.7%) and 161 professors (response rate of 86.6%) participated. Among coordinators, 70% reported that SDB was not included in the curriculum, 66.7% reported a lack of trained faculty, and none reported continuing education programs. Only 2.5% of institutions had a dental sleep medicine clinic, and the mean workload devoted to SDB content in the undergraduate curriculum was 5.6 h. Among professors, 93.2% considered SDB instruction important, but only 25.5% included it in their teaching. Few faculty members reported routinely asking about snoring or other sleep-related symptoms during clinical activities. Most (76.4%) classified dentists' training in OSA as deficient, and 92.5% agreed that curricula should cover OSA. Despite recognition of its relevance, SDB education is largely absent from Brazilian dental curricula. Findings suggest a need for curricular reform, faculty development, and expanded clinical training opportunities. Future studies should triangulate data sources and explore innovative teaching strategies to address these curricular gaps.
To overcome the reliance on subjective clinical judgment and the inadequacy of international indices in reflecting Chinese orthodontic expertise and patient characteristics, the Chinese Stomatological Association developed an expert consensus on orthodontic treatment outcome evaluation. This first systematically calibrated framework tailored to Chinese populations was established through an extensive process: comprehensive literature review, analysis of the Peer Assessment Rating (PAR) and the American Board of Orthodontics Objective Grading System (ABO-OGS) indices and a large-scale subjective-objective correlation study involving 65 standing committee members evaluating 216 completed cases. The resulting 3D evaluation system encompasses occlusal relationships, root and bone health and facial profile harmony. Occlusal assessment includes six core indicators: incisor horizontal overlap, vertical overlap, sagittal relationship, alignment, occlusal contact and buccal lingual inclination. Root and bone health evaluation mandates CBCT-based assessment of root resorption, fenestration and dehiscence, the first mandatory inclusion of 3D radiographic evaluation in orthodontic outcome standards. Facial profile analysis comprises five cephalometric measurements (ANB, MP/SN, Sn-GPos, UL-E and Bs-GPos) evaluated using a standardised difference method. Each dimension provides detailed specifications for evaluation materials, objective indicators, measurement methods, scoring criteria and a five-grade classification (excellent, good, fair, poor and worst) based on total deduction scores aligned with expert consensus percentiles. This consensus aims to standardise clinical practice, establish a scientific foundation for treatment quality control and specialist certification, provide morphological evaluation criteria for research and enhance orthodontic care quality in China. Despite being focused on static morphology, the framework is designed to accommodate future integration of functional assessment and long-term stability evaluation.
To compare the efficacy of sliding mechanics on a 0.020-inch round posterior segment incorporated into a bi-dimensional archwire (BA) versus conventional rectangular-section archwire (CONV) for maxillary canine retraction, rotation, angulation, anchorage loss, overbite change, and external apical root resorption (EARR). Randomized, parallel-group, two-arm clinical trial with 1:1 allocation. Department of Orthodontics, University of Damascus; recruitment and treatment July-December 2023. Patients aged 18-25 years with mild-moderate skeletal Class II (ANB + 5° to + 7°) and 5-10 mm overjet scheduled for camouflage treatment with extraction of maxillary first premolars were randomized (N = 38) to: (a) BA-bi-dimensional archwire (0.021 × 0.025″ rectangular in the incisor segment; 0.020″ round in canine/premolar/molar slots) or (b) CONV-conventional rectangular-section retraction mechanics. Primary outcome was monthly maxillary canine retraction rate measured on digitally scanned casts (3D analysis). Secondary outcomes included canine rotation rate, canine angulation change (lateral cephalograms), anchorage loss, overbite change, and EARR (panoramic radiographs). Computer-generated variable block randomization (block sizes 4 and 6) produced by an independent statistician. Sequentially numbered, opaque, sealed envelopes prepared and stored by the independent statistician; opened after eligibility and baseline assessment. Participants and treating clinicians were unblinded; outcome assessors and the study statistician were blinded. Radiographs and digital models were anonymized and allocation was held independently until primary analyses were locked. Thirty-eight participants (19 per arm) completed the study. Observed median retraction rates (T0→TF; T0 = baseline, TF = end of retraction) were BA 1.17 mm/month (IQR 0.20; bootstrap 95% CI 1.08-1.24) versus CONV 0.82 mm/month (IQR 0.13; bootstrap 95% CI 0.76-0.90). Linear mixed-effects modelling adjusted for baseline overjet showed a significant group effect favoring BA (p < 0.001). BA reduced total canine angulation change by 2.90° (95% CI - 4.97 to - 0.82; p = 0.007). Secondary outcomes (rotation, anchorage loss, overbite, EARR) showed only small differences or non-significant trends after Bonferroni adjustment. Incorporating a 0.020″ round posterior segment within a bi-dimensional archwire accelerated canine retraction (~ 43% relative increase) and improved mesiodistal angulation control compared with conventional rectangular mechanics, without clear clinically meaningful increases in rotation, anchorage loss, overbite change, or root resorption. Findings warrant confirmation in larger, multicenter trials with extended 3D imaging follow-up. University of Damascus (Reference no.: 501100020595). Trial registration ClinicalTrials.gov NCT07243509 (retrospectively registered 24 November 2025).
Prolonged orthodontic treatment is associated with adverse clinical outcomes such as enamel white spot lesions and root resorption, and micro-osteoperforation (MOPs) is a minimally invasive intervention for accelerating orthodontic tooth movement (OTM). This meta-analysis aimed to evaluate the efficacy of MOPs in accelerating OTM, assess its potential adverse effects on periodontal tissues, root structure and anchorage, and summarize the optimal application parameters of MOPs for clinical practice. A systematic literature search was conducted in PubMed, Web of Science, EMBASE, Scopus, Cochrane Library, LILACS, and Google Scholar, with 16 randomized controlled trials (RCTs) included after screening 1,175 records. This study was registered in the PROSPERO International Prospective Register of Systematic Reviews (registration number: CRD420251149503). The Cochrane ROB 2 tool was used to assess the risk of bias of included studies, and the GRADE approach was applied to evaluate the certainty of the cumulative evidence. Compared with traditional orthodontic treatment, the MOPs group achieved an increase of 0.67 mm (95% CI: 0.45-0.88) in the total OTM distance and a monthly increase of 0.20 mm (95% CI: 0.13-0.26) in the OTM rate. Multiple MOPs significantly increased the total OTM distance (1.17 mm, 95% CI: 0.21-2.13) compared with single MOPs (0.61 mm, 95% CI: 0.45-0.77), while the monthly OTM rate remained stable at approximately 0.2 mm. For secondary outcomes, MOPs was associated with a non-clinically significant increase in root resorption (mean difference: 0.19 mm, 95% CI: -0.14 to 0.51), no significant anchorage loss, and mild, transient adverse effects on periodontal parameters (e.g., slight increase in probing depth). Postoperative pain in the MOPs group was significantly higher on the surgery day but diminished rapidly, with no long-term impact on patients' quality of life. Subgroup analyses showed that mandibular MOPs, repeated MOPs application, and the use of the Propel device were associated with enhanced acceleration effects. The included studies had an overall low risk of bias in randomization, incomplete outcome data and selective reporting domains. Moderate risks of performance and detection bias were present across all studies due to the inherent inability to blind participants and operators for surgical interventions such as MOPs. MOPs appears to be an effective adjunctive approach for accelerating orthodontic tooth movement without causing clinically significant damage to root structure, anchorage, or periodontal tissues. Meanwhile, long-term outcomes and optimal application parameters-such as the number, depth, and frequency of perforations-require further investigation. Clinical implementation should be individualized based on patient characteristics and treatment objectives. https://www.crd.york.ac.uk/PROSPERO/recorddashboard, PROSPERO CRD420251149503.
Objectives. Pneumoconiosis is a concerning occupational health hazard in dentistry. This cross-sectional study aimed to estimate the prevalence of pneumoconiosis and its association with age, gender, type of dental profession and duration of exposure among dental healthcare professionals (DHCPs). Methods. The study enrolled 138 DHCPs from an Indian tertiary care dental teaching institution who underwent structured face-to-face interviews, clinical examination, spirometry and chest radiography interpreted using International Labour Organization (ILO) classification. Potential pneumoconiosis was defined based on occupational exposure, clinico-spirometric examination and radiological findings consistent with pneumoconiosis (ILO category ≥ 1/0). The χ2 test was applied to examine association of demographic-occupational characteristics with clinical symptoms, spirometric findings, radiologic findings and pneumoconiosis occurrence. Results. The prevalence of pneumoconiosis was 3.6%, with 4.3% of subjects showing radiographic opacities. Spirometry results showed a restrictive pattern in 13.8% of participants. The frequency of potential pneumoconiosis based on clinical symptoms and radiological findings was significantly associated with age > 35 years (particularly among dental technicians) and duration of exposure > 20 years, respectively. Conclusions. Increased susceptibility of DHCPs, especially dental technicians, towards pneumoconiosis highlights the importance of adoption of stringent occupational health and safety precautions, and regular clinico-radiographic screening for timely detection of pneumoconiosis.
Appropriate antibiotic prescribing is a core competency in dental education. This study evaluated dental students' knowledge, antibiotic selection patterns, and adherence to international guidelines for the management of endodontic infections. An online survey was administered to students in their final two clinical years across 19 countries. Three clinical scenarios were evaluated: first-line antibiotic choice, second-line when the first choice is ineffective, and drug of choice for penicillin-allergic patients. Participants reported drug, dose, frequency, and duration. Guideline adherence was quantified using a 0-5 scoring system based on European Society of Endodontology and American Association of Endodontists recommendations. Mixed-effects linear regression models with country as a random effect were used to identify predictors of guideline-concordant prescribing. A total of 4226 responses were analysed. Amoxicillin was the most frequently selected first-line antibiotic (57.6%), followed by amoxicillin-clavulanic acid (18.4%), with marked between-country variation; adjusted first-choice concordance was highest in Colombia (4.57) and lowest in Bangladesh (2.49). For second-line therapy, amoxicillin-clavulanic acid predominated (33.2%), with the highest adherence in Ecuador (3.40) and the lowest in Switzerland (2.15). In penicillin-allergic patients, clindamycin was most commonly selected (47.8%), but allergy-specific concordance varied widely, ranging from 3.52 in Colombia to 1.06 in India. Age positively predicted second-line concordance, while lower allergy-specific concordance was observed among second-year students and males. Marked variability and frequent deviations from guideline-recommended prescribing highlight persistent educational gaps. Strengthening antimicrobial stewardship training within undergraduate dental curricula is warranted.
This scoping review aimed to map the available evidence on clear aligner attachments, summarise key themes and identify gaps to inform clinical practice and future research. This review was registered in the Open Science Framework database. A systematic search was conducted across PubMed, Scopus, Web of Science and Embase databases in accordance with PRISMA-ScR guidelines. The search strategy was systematically constructed using Boolean operators to capture the core literature related to clear aligners and attachments. Searches were conducted up to 30 August 2025. Studies focusing on attachments in clear aligner therapy published between 1 January 2005 and 30 August 2025 were included without restrictions on study design, except narrative reviews. Both primary studies and secondary studies (systematic reviews) were eligible and mapped in this scoping review. Data were systematically charted using a standardised form capturing key variables including study design, year of publication, country of origin, research objectives and outcomes relevant to clear aligner attachments. A total of 115 studies were finally included. In vitro studies predominated, representing 72.1% of the total. Most research was conducted in China and Turkey, with a total of 23 countries represented. The United States, China, Australia and Italy led in international research collaborations. A noticeable increase in publications was observed from 2020 onward, reaching a high point in 2025. Five major thematic areas were identified: Biomechanics and tooth movement, bonding and debonding, attachment materials, patient-reported outcomes and adverse effects, and aligner retention. Evidence was concentrated in biomechanics and bonding/material studies, whereas patient-reported outcomes (comfort/acceptability) and safety-related aspects (e.g., material elution/exposure) were relatively underexplored. Current evidence on clear aligner attachments is mostly in vitro-based, leaving its actual clinical effectiveness unclear. More clinical, multicentre and standardised studies are needed to strengthen and unify our understanding of clear aligner attachments.
Laceback ligatures are passive stainless-steel auxiliaries tied from the first permanent molar hook to the canine bracket during the alignment phase of orthodontic fixed appliance treatment, predominantly in premolar extraction cases. Despite equivocal evidence on their effectiveness in controlling anterior tooth position, lacebacks are routinely used to stabilize flexible nickel-titanium archwires against masticatory forces. Their effects on 3 clinically important outcomes, oral hygiene, appliance complication rates, and patient-reported pain, have never been investigated in a randomized trial, representing gaps explicitly identified in a prior systematic review. This study aims to evaluate the clinical and patient-reported outcomes of passive laceback ligatures during the alignment phase of orthodontic fixed appliance treatment, specifically oral hygiene status, archwire and laceback complication rates, and pain. This is a single-center, single-blind, split-mouth randomized controlled trial conducted at the Orthodontic Clinic, International Islamic University Malaysia. Eligible participants are patients aged 15 years and older, medically fit with Basic Periodontal Examination scores of 0-2, requiring full fixed appliance treatment with bilateral premolar extractions and no prior orthodontic treatment. Those with craniofacial deformities, systemic illness, or disability affecting oral hygiene compliance are excluded. Each participant's oral cavity is randomly allocated using a minimization method, so that one side receives a passive 0.010-inch stainless-steel laceback from the first molar hook to the canine bracket, while the contralateral side receives identical standard fixed appliance treatment (McLaughlin, Bennett, and Trevisi prescription brackets, 0.014-inch superelastic nickel-titanium archwires, and elastomeric modules) without laceback. Outcomes are assessed at baseline (T0), 4 weeks (T1), and 8 weeks (T2) after laceback placement. The primary outcome is the orthodontic plaque index. Secondary outcomes include archwire and laceback complication frequencies and pain assessed by visual analog scale area under the curve. A total of 38 participants provided 85% power to detect a 1-unit orthodontic plaque index difference (α=.05). Mixed-model repeated-measures analysis is applied to plaque scores; paired parametric or nonparametric tests to other outcomes. Plaque and archwire assessors are blinded to treatment allocation. Ethical approval and funding were secured in January 2026. Participant recruitment commenced in February 2026 with a target completion of June 2027. Pretrial examiner calibration achieved satisfactory agreement (interrater Cohen kappa=0.801-0.804; intrarater reliability=0.806-0.862). As of paper submission, 24 participants have been enrolled, and 14 have completed all data collection visits, with no protocol deviations recorded. Primary analysis is scheduled for October 2027; the results are targeted for submission by June 2028. This protocol describes the first randomized controlled trial to simultaneously evaluate oral hygiene, appliance complication rates, and patient-reported pain associated with laceback use during orthodontic alignment. The split-mouth design controls for interparticipant confounders, and the incorporation of patient-reported outcomes will ensure that findings directly support evidence-based, patient-centered orthodontic practice.
The diagnostic accuracy of caries detection on bitewing radiographs varies among dentists and is strongly influenced by lesion severity. Improving the detection of initial and extensive carious lesions remains clinically important for appropriate treatment planning. This study evaluated the diagnostic performance of a deep learning-based detection model and compared its performance with that of general dentists in detecting caries on bitewing radiographs of primary teeth, applying lesion severity criteria relevant to clinical caries management. A total of 1,427 bitewing radiographs was included, with 1,180 allocated for training and validation, and 247 for testing. As the reference dataset, two experienced dentists annotated carious lesions according to six depth categories based on the International Caries Classification and Management System (ICCMS™). The diagnostic performance of YOLOv8 and the general dentists were compared using recall, precision, F1-score, average precision (AP), and mean average precision (mAP) at an intersection over union (IoU) threshold of 50%. YOLOv8 outperformed the general dentists in recall (0.51 vs. 0.29), precision (0.41 vs. 0.31), F1-score (0.44 vs. 0.29), and mAP (0.41 vs. 0.22). Both YOLOv8 and the general dentists demonstrated greater diagnostic accuracy for extensive carious lesions than for initial lesions. Based on the pattern of mispredictions, YOLOv8 tended to underestimate lesion severity, predicting shallower depths than those annotated in the reference dataset, whereas the general dentists exhibited a tendency to overestimate lesion depth. The deep learning-based model demonstrated superior performance to the general dentists across all evaluated metrics and lesion classes. These findings support the potential role of deep learning as an adjunctive tool for radiographic caries assessment on bitewing radiographs of primary teeth.
Due to the shift in focus on outcomes, instead of time-bound training, competency-based models have become widely accepted in health professions education. In the context of orthodontic diagnostic procedures and biomechanical challenges, specialty-specific skills such as designing and treatment planning are critical for health practitioners. The latest literature has recognized the core competencies pertinent to postgraduate orthodontic training in the field, yet there continues to be notable variability in program quality, clinical knowledge, and competency tests between training programs. The objective of this review is to design an integrated competency-based dental education (CBDE) model for postgraduate orthodontic training that encompasses the management of students' competencies by correlating competency domains with specific program outcomes (POs) and course outcomes (COs), introducing entrustable professional activities (EPAs) to translate competencies into clinical practice, aligning assessment strategies, and utilizing systematic curriculum mapping to ensure coherence and comprehensive competency attainment. To synthesize the evidence surrounding competency-based dental education (CBDE) and competency frameworks in postgraduate orthodontic training, a narrative review of the literature was conducted focusing on CBDE, postgraduate orthodontic education, competency domains, curriculum design, assessment strategies, and EPAs. Relevant references were determined from the orthodontic education consensus studies, CBDE literature, and systematic reviews. In total, 10 orthodontic competency areas, 10 POs, and 11 COs were identified methodically. Ten essential EPAs associated with independent orthodontic practice were then created to operationalize these competencies in clinical practice settings. With this in mind, a three-year curriculum was designed, rooted in elements that aligned with CBDE principles to include competency mapping, assessment techniques, and introducing digital technologies to support teaching, learning, and assessment. This proposed framework provides a clear, distinct, and structured solution to training orthodontic specialties, which would enable it to be embraced as a reference structure for the reform in curriculum on an international level as well. Recent evidence supports the call for standardized orthodontic competencies and a competency-based method of assessment to promote uniformity and quality of postgraduate orthodontic education.
Skeletal Class III malocclusion represents a significant challenge in orthodontics due to its impact on facial aesthetics and function, particularly in patients with limited residual growth. Bone-anchored maxillary protraction (BAMP) with miniplates has emerged as an effective alternative to conventional orthopaedic approaches, providing greater skeletal effects with less dentoalveolar compensation. This study reports the clinical management of a patient with limited growth potential and skeletal Class III malocclusion, treated with miniplate-assisted maxillary protraction followed by aligner therapy. A 9-year-8-month-old female patient, presenting with maxillary retrusion and mild mandibular protrusion (SNA=79.2°, SNB=80.8°, ANB=-1.6°, AO-BO=-11.1mm), was treated with four Bollard miniplates and Class III elastics for 9 months. The orthopaedic phase resulted in significant maxillary advancement (SNA increased to 85.1°), improved sagittal relationship (ANB increased to 3.5°), and improved Wits score from -11.1mm to 1.8mm, with minimal changes in mandibular position. Structural overlays demonstrated that the maxillary advancement achieved during the orthopaedic phase was accompanied by vertical mandibular development during the orthodontic phase, thereby favourably redirecting the initial hypodivergent pattern and improving facial balance. Subsequent orthodontic refinement was performed with clear aligners, totalling 130 aligners in multiple refinement stages, leading to Class I relationships in the canines and molars, improved intercuspation, and correction of midline deviation. Although aligner therapy required multiple refinements, satisfactory functional and aesthetic results were obtained without the need for orthognathic surgery in this case. Maxillary protraction assisted by miniplates followed by aligner therapy was effective for the treatment of this case of skeletal Class III malocclusion.
This systematic review and meta-analysis evaluated and compared the diagnostic utility of spheno-occipital synchondrosis maturation and the cervical vertebral maturation index for identifying mandibular growth parameters in adolescents. Longitudinal and mixed-longitudinal human studies that assessed spheno-occipital synchondrosis maturation and/or the cervical vertebral maturation index as index tests against mandibular growth parameters as the reference standard were considered eligible. Cross-sectional studies without a longitudinal growth reference and studies lacking extractable diagnostic accuracy data were excluded. A comprehensive search of PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library was performed from database inception to the final search date, and grey literature was additionally screened through ProQuest Dissertations & Theses, selected university repositories, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. Risk of bias and applicability concerns were independently assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Sensitivity estimates were derived from 2 × 2 contingency tables and pooled using a random-effects model, while the association between spheno-occipital synchondrosis maturation and cervical vertebral maturation index stages was synthesized through correlation meta-analysis. Six studies involving adolescents approximately 10 to 19 years of age met the inclusion criteria. Three longitudinal studies were included in the diagnostic accuracy meta-analysis for the cervical vertebral maturation index, and three cross-sectional studies contributed four datasets to the correlation meta-analysis examining the relationship between spheno-occipital synchondrosis maturation and the cervical vertebral maturation index. The cervical vertebral maturation index demonstrated moderate diagnostic performance for identifying mandibular growth phases, although sensitivity estimates varied notably across studies. Spheno-occipital synchondrosis maturation showed a strong pooled association with mandibular growth and skeletal maturation, with a random-effects correlation of approximately 0.8, although heterogeneity was considerable. Overall, both measures appear clinically informative for estimating mandibular growth timing in adolescents, with spheno-occipital synchondrosis maturation showing a strong relationship with skeletal maturation and the cervical vertebral maturation index demonstrating moderate diagnostic value for identifying phases of mandibular growth. No external funding was received. This review was registered in PROSPERO (CRD420251175309).
Clear aligner therapy (CAT) has transformed contemporary orthodontic practice; however, evidence regarding its adoption and clinical use among specialist orthodontists remains scarce. This study investigated CAT practices among Iranian specialist orthodontists. This study forms part of the Cardiff University International Aligner Survey: Orthodontists" Practices and Perceptions. A web-based cross-sectional survey of specialist orthodontists in Iran was conducted from October 2025 to January 2026. A voluntary, anonymous English-language questionnaire assessed demographics, CAT usage patterns, adjuncts, training, preferred malocclusions and patient age groups, monitoring and retention protocols, and perceived advantages and limitations. A total of 142 specialists (16%-20% estimated response rate) responded (83 male, 59 female). Most were aged 30-39 years (47.2%), had 11-20 years of experience (40.8%), and worked in private practice (59.9%). CAT was used by 69% of respondents; 35.9% treated <10 new CAT cases annually, while 7.7% treated >50. For 51.4%, CAT comprised about 10% of their caseload; only 2.8% reported CAT use in >50% of cases. CAT was used mainly in adults and least in mixed dentition/adolescents (P < 0.001). Preferred indications were mild crowding (<4 mm; 81.6%), spacing/diastema (63.1%), anterior crossbite (44.3%), and mild open bite (1-2 mm; 38.6%). CAT was favoured for single-extraction or space-opening cases rather than complex extractions or orthognathic surgery. About 8.5% reported using a hybrid approach, consisting of CAT in one arch combined with fixed appliance therapy in the opposing arch. Elastics were the most common adjunct. Intraoral 3D scanners were the most common method (68.1%) for taking records among respndents (n = 141). Approximately, 49.3% and 19% of aligners were provided by local manufacturers or produced in-office, respectively. Most orthodontists recognised biomechanical limitations of CAT (agree and strongly agree), with 73.3% reporting limited control of tooth movement, 77.5% inadequate torque expression, 88.7% difficulty achieving certain tooth movements, and 88.8% a limited scope for complex cases. Furthermore, 68.1% believed CAT may require longer treatment times than fixed appliances, and 83.1% agreed that CAT often necessitates greater interproximal reduction than fixed appliance therapy. CAT was mainly used for mild malocclusions, supported by expanding local aligner manufacturers and in-office aligner production.
This study aimed to translate, culturally adapt, and estimate the psychometric properties of the Catastrophizing Questionnaire (CQ) for use in Portuguese among orthodontic patients. The translation process followed international guidelines, including forward and backward translation. Confirmatory factor analysis (CFA) was conducted to assess factorial validity, using indices such as the Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Root Mean Square Error of Approximation (RMSEA), and Standardized Root Mean Square Residual (SRMR). Convergent validity [Average Variance Extracted (AVE)] and reliability were estimated. A total of 334 Brazilian orthodontic patients (74.6% female, mean age = 30.6 years, standard deviation 12.4) participated in the study. The factor model of the Portuguese version of CQ presented an adequate fit to the data (CFA: CFI = 0.95, TLI = 0.94, RMSEA = 0.07, and SRMR = 0.06). Reliability was acceptable (α and ω ≥ 0.93). Although the AVE was slightly below the recommended threshold (AVE = 0.41), the overall model fit and internal consistency supported the adequacy of convergent validity. The Portuguese CQ showed adequate psychometric properties for assessing catastrophizing in Brazilian adult orthodontic patients. As a pain-independent measure, it enables the early identification of catastrophizing tendencies before appliance placement, supporting a patient-centered approach. By helping clinicians recognize individual psychosocial vulnerabilities, the CQ can guide tailored communication and management strategies aimed at improving the overall treatment experience. Este estudo teve como objetivo traduzir, adaptar culturalmente e estimar as propriedades psicométricas do Questionário de Catastrofização (QC) para uso em português em pacientes ortodônticos. O processo de tradução seguiu diretrizes internacionais, incluindo tradução direta e retrotradução. Foi realizada análise fatorial confirmatória (AFC) para avaliar a validade fatorial, utilizando índices como o Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Root Mean Square Error of Approximation (RMSEA) e Standardized Root Mean Square Residual (SRMR). A validade convergente [Variância Extraída Média (VEM)] e a confiabilidade foram estimadas. Participaram do estudo 334 pacientes ortodônticos brasileiros (74,6% do sexo feminino, idade média = 30,6 anos, desvio-padrão = 12,4). O modelo fatorial da versão em português do QC apresentou ajuste adequado aos dados (AFC: CFI = 0,95, TLI = 0,94, RMSEA = 0,07 e SRMR = 0,06). A confiabilidade foi adequada (α e ω ≥ 0,93). Apesar da VEM ter apresentado um valor marginalmente inferior ao ponto de corte recomendado (VEM = 0,41), o ajuste geral do modelo e a consistência interna corroboraram a adequação da validade convergente. A versão portuguesa do QC demonstrou propriedades psicométricas adequadas para avaliar traços de catastrofização em adultos brasileiros submetidos a tratamento ortodôntico. Por se tratar de uma medida independente da dor, o QC possibilita a identificação precoce de tendências ao catastrofismo antes da instalação do aparelho ortodôntico, favorecendo uma abordagem centrada no paciente. Ao auxiliar os clínicos a reconhecer vulnerabilidades psicossociais individuais, o QC pode orientar estratégias de comunicação e manejo personalizadas, com o objetivo de aprimorar a experiência geral do tratamento.
To evaluate the accuracy of maxillary canine and anchorage tooth movement in first premolar extraction cases at final canine retraction, using In-house clear aligners (IHCA), by comparing the palatal power arm (PA) to control (C). A single-center randomized controlled trial with a split-mouth design was used. University. Eighteen adults requiring extraction of maxillary first premolars were recruited and received multi-stage IHCA treatment. Outcomes include 3 linear (mesio-distal, bucco-lingual, extrusion-intrusion) and 3 angular (tipping, rotation, torque) measurements. The primary outcome was canine distalization. Sequence generation: Patients were assigned to the PA and control sides using sequence-based randomization (Research-Randomizer website). Allocation concealment and blinding were not feasible. Pretreatment and canine final aligner virtual and actual digital models were superimposed using the 3D GOM-Inspect-Suite software to assess 6 types of tooth movement. Equivalence testing with Holm-Bonferroni correction was used to compare mean differences and 90% confidence intervals (CI) between PA and control sides for maxillary canines and anchorage teeth. For canine linear movements, the mean differences ranged from -0.19 to 0.09 mm, with corresponding 90% confidence intervals entirely within the predefined equivalence margins of ± 0.5 mm, indicating practical equivalence. In contrast, canine rotation was not equivalent, with a mean difference of 5.22° and a 90% CI of (1.48, 8.95), which exceeded the predefined equivalence bounds of ± 1.5°. Similarly, canine distal crown tipping failed to demonstrate equivalence, with a mean difference of 1.67° and a 90% CI of (- 0.44, 3.78). For anchorage movements, most linear outcomes met the equivalence criteria, except for premolar mesialization and molar buccalization, whereas angular outcomes generally did not, as their confidence intervals were not fully contained within the equivalence region. These findings suggest loss of anchorage on both sides, characterized by mesial crown tipping and relative intrusion, indicating that the PA may not significantly preserve anchorage. Linear movements were equivalent between the PA and control, whereas canine angular movements did not demonstrate equivalence. Potential benefit of PA in angulation and rotation control should be interpreted with caution. These findings may have limited generalizability, especially to commercial aligners. Trial Registration Current Controlled Trials ISRCTN 14020146 of the International Standard Randomized Controlled Trial.