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Women remain underrepresented in the academic world. This study aimed to compare the numbers of female and male authors in high-impact orthodontic journals during the pre- and post-COVID-19 pandemic periods. A total of 7902 papers published in eight orthodontic journals (American Journal of Orthodontics and Dentofacial Orthopedics, Angle Orthodontist, European Journal of Orthodontics, Journal of Orofacial Orthopedics, Journal of the World Federation of Orthodontists, Korean Journal of Orthodontics, Orthodontics & Craniofacial Research, and Progress in Orthodontics) were screened. They were divided into two groups: Group 1 (G1): Pre-pandemic (2015-2019) and Group 2 (G2): Post-pandemic (2020-2024). The data were collected manually, including the journal, type of study, gender, and authorship position. Descriptive statistical analyses were used. The sex of the authors before and after the pandemic was compared using the chi-square test. The Mann-Whitney U test was used to compare the total number of authors and the total number of male and female authors. 5494 papers were evaluated and included in the study. There was no significant difference in gender distribution in single-authored papers. After the pandemic, there was a significant increase in women in first and last author positions. The total number of authors and proportion of female authorship in intermediate positions increased significantly post-pandemic. The European Journal of Orthodontics was the only journal that had more female first authors than males in the post-pandemic period. The pandemic has not negatively affected female participation in orthodontic publications. There was a significant increase in female authorship after 2020, indicating a gradual reduction in gender disparities in this field.
The aim of this study was to evaluate the effectiveness and side effects of in-office 3D-printed mandibular advancement device (MAD) in the treatment of obstructive sleep apnea (OSA). The study included 23 patients. A novel type of 3D-printed MAD was developed specifically for the treatment of OSA. At the beginning of therapy, orthodontic documentation was obtained. During follow-up visits, a cone-beam computed tomography scan was performed with the MAD in situ to verify changes in the airways, and patients were referred to a sleep laboratory to assess the effectiveness of the therapy. After 1 year of treatment, orthodontic documentation was repeated, and the side effects of MAD therapy were noted. Patients also completed questionnaire to evaluate the subjective effectiveness of the treatment. Side effects were observed during MAD therapy for OSA. These side effects were primarily related to dentoalveolar compensation, most notably changes in the position of the upper (2.22° P < 0.001) and lower (1.91°, P = 0.003) incisors and alterations in occlusion. A statistically significant increase was observed in the maximum cross-sectional area (72.62 mm2, P < 0.001). The therapy was objectively successful in 74% of patients. Subjectively, all patients reported an improvement in their condition. The study did not reveal any direct association between the use of the MAD and temporomandibular joint damage in the study cohort. In-office 3D-printed, titratable MADs represent easily fabricated therapeutic option for OSA treatment, with favorable clinical outcomes. They may offer a solution for a broad spectrum of patients.
The World Federation of Orthodontists (WFO) recognizes the growing impact of online media in shaping public understanding of orthodontics. In response to the proliferation of misinformation and disinformation, particularly on digital platforms, the WFO has developed comprehensive guidelines aimed at ensuring accuracy, objectivity, and ethical standards in online orthodontic content. These guidelines serve to inform WFO fellows and affiliates involved in creating or managing web-based orthodontic resources. A detailed policy framework was established by the WFO to address key elements of digital communication. These include content definition, site ownership and access, payment structures, privacy protocols, sponsorship disclosures, funding transparency, and ethical advertising practices. Special emphasis was placed on promoting source verification, critical appraisal of content, and user engagement strategies to combat misinformation. The policy was developed through expert consensus and informed by best practices in health communication and evidence-based dentistry. The guidelines provide a structured approach to enhancing the credibility and reliability of online orthodontic information. By delineating clear standards for ethical content creation and dissemination, the WFO aims to safeguard public trust and support informed decision-making. The policy addresses modern challenges posed by social media and other user-driven platforms, offering practical strategies for orthodontists to promote evidence-based information and patient education. A commitment to regular review ensures the framework remains adaptive to the evolving digital environment. The WFO online content guidelines establish a robust foundation for ethical, accurate, and transparent communication in orthodontics. By adhering to these principles, WFO members and affiliates can actively contribute to reducing misinformation, enhancing patient understanding, and upholding the integrity of the profession. Ongoing updates will ensure alignment with technological advancements and emerging communication trends.
This World Federation of Orthodontists (WFO) white paper addresses the escalating environmental impact of orthodontic practices, synthesizing expert perspectives on sustainable transformation. The paper critically evaluates the environmental footprints associated with orthodontic materials, energy consumption, and waste management across diverse global settings. It examines the impact of both traditional and emerging digital technologies, highlighting the challenges of material selection, recycling limitations, and energy-intensive procedures. Recommendations focus on adopting eco-friendly materials, minimizing resource consumption, promoting responsible waste disposal, and integrating digital workflows to improve efficiency. It emphasizes the need for standardized guidelines and collaborative efforts among orthodontists, researchers, manufacturers, and policymakers to achieve a more sustainable future for the profession. The discussions in this manuscript delve into various aspects, including material use, waste management, and potential avenues for sustainable transformation of orthodontic practices. The goal is to foster a collective commitment to reducing the environmental impact of orthodontics, ensuring a healthier planet for future generations.
In animal studies we have shown that the inflammatory response and rate of tooth movement triggered by orthodontic force reach a saturation point beyond which increased force produces no additional response. In addition, our previous clinical study found that adolescents and adults have different inflammatory response, tooth movement rates, and pain with increasing orthodontic forces. Based on these findings, our goal in this study was two-fold. First, to determine if there is a saturation point for the inflammatory response and tooth movement rates in orthodontics patients. Second, to determine if age impacts the saturation point. We conducted a non-randomized, single-center, single-blinded clinical study on two groups of healthy subjects who required first premolar extraction and canine retraction to correct their malocclusion. Adolescents (11-14 years old) and adults (21-45 years old) of both sexes were recruited and randomized within their age group (n = 4 per force) to receive one of the following four magnitudes of force during canine retraction: 50, 100, 150, and 200 cN Gingival crevicular fluid (GCF) from the distolabial crevice of the canine was collected to assay inflammatory marker levels before treatment and one day after beginning retraction. IL-1β, CCL2, and RANKL proteins were quantified using a slide-based protein array assay. Study models were used to assess canine retraction after 28 days of force application. Differences within and between treatment groups were assessed statistically. We found that inflammatory cytokine levels and the rate of tooth movement reached its maximum at 100 cN or 150 cN for adults and adolescents respectively. Adolescents had lower cytokine levels at lower magnitude forces than adults, but the levels increased at higher magnitude forces, with adults reaching saturation sooner than adolescents. The rate of canine movement in 28 days was not significantly different between adolescents and adults at any force level. However, the rate was higher in adolescents for all force groups. As in our animal studies, humans demonstrate a saturation point for inflammatory responses and the rate of tooth movement to orthodontic force. Adults reached saturation of the biological response earlier, while younger patients had a higher saturation point. This study has important clinical significance as it may guide orthodontists toward optimizing orthodontic forces and treatment duration, while reducing the risk of pathology arising from excessive forces.
The present study assessed the performance of four prominent chatbots (ChatGPT-4o, Grok 3, Gemini Advanced, and Claude 3.7 Sonnet) in answering orthodontics- and dentofacial orthopedics-related multiple-choice questions (MCQs). One hundred MCQs were prepared by three orthodontic consultants. These questions, each with four potential answers, covered basic and advanced orthodontic knowledge and clinical case scenarios. The chatbots' answers were assessed twice at a one-week interval. Three orthodontists' answers were reported once on a Google Form. Performance was measured as the percentage of correct answers, while consistency was measured as the McNemar test and Cohen's Kappa. A P ≤ 0.05 was considered significant. The chatbots' performance ranged from 72% to 84% and from 79% to 85% in the first and second rounds, respectively. Orthodontists' performances ranged from 71% to 84%. The highest intrachatbot consistency was observed for Grok 3 (McNemar P = 1, and Kappa = 0.793), while the lowest was for Gemini Advanced and ChatGPT-4o (McNemar P = 0.001 and 0.167, respectively, and Kappa = 0.490 each). The interchatbot consistencies showed variability over time and were significantly different between Grok 3 and Claude 3.7 Sonnet (McNemar P = 0.109, and Kappa = 0.677) in the first round and between Gemini Advanced and Claude 3.7 Sonnet (McNemar P = 0.344, and Kappa = 0.647) in the second round. The consistencies among the orthodontists and between the orthodontists and chatbots were highly variable. The performance of the evaluated chatbots in answering MCQs in orthodontics and dentofacial orthopedics is still below expectations, although it was slightly better than that of orthodontists. Substantial inconsistencies existed among the chatbots, thus making them unsuitable for completely replacing existing educational methods and strongly suggesting that further improvement, continuous updating, and assessments are needed.
Molar distalization has generated additional attention with the advent of skeletal anchorage devices. However, relapse after distalization is one of the challenges and the quantum of relapse following distalization, especially over the long-term remains controversial. This systematic review and meta-analysis aim to evaluate the long-term vertical and sagittal stability of molars postdistalization. A systematic search was conducted in electronic databases (PubMed, Scopus, Ovid, Embase, Cochrane and LILACS) up to April 11, 2025. Studies assessing molar position changes after active distalization and during follow-up periods were included. Data extraction and risk of bias assessments were performed using the ROBINS-I tool for non-randomized studies. A meta-analysis was conducted to quantify relapse in vertical and sagittal dimensions. From the 2594 studies initially identified, six studies (all nonrandomized control trials) were included for the systematic review and five studies were included for the meta-analysis. All studies showed moderate risk of bias. The mean relapse in the sagittal plane was 1.58 ± 0.84 mm (35%) linearly and 2.98 ± 2.07° (53%) angularly. In the vertical plane, it relapsed by 1.44 ± 1.26 mm. Meta-analysis showed a net distalization in the molar position in long-term sagittal plane by 2.77 mm (95% CI 2.33-3.20) and 1° distally (95% CI -2.37° to 4.38°), and in the vertical plane by -0.65 mm (95% CI -2.27 to 0.96). The I2 ranged from 60% to 98% indicating high heterogeneity. The relapse was minimal for the incisal, skeletal, and soft tissues parameters. Long-term assessment following molar distalization demonstrated conclusive evidence of relapse in the sagittal and vertical direction. There was greater relapse in the vertical than in the sagittal direction. There was minimal literature assessing the relapse in the transverse direction. Hence, this systematic review advocates the need for long-term retention postdistalization.
Facial soft tissue analysis plays a vital role in orthodontics, orthognathic surgeries, and forensic anthropology. This study aimed to determine a standardized midline to assess the reliability of symmetry analysis in frontal view photographs. Additionally, it evaluated the consistency of soft tissue landmark detection and analysis between different observers and over time. A power analysis determined the need for a total of 50 standardized frontal-view photographs. These photographs were obtained from Iranian patients aged 9-40 who were undergoing orthodontic treatment. Thirty-seven standardized landmarks were annotated across the face, facilitating 73 distinct facial analyses. Five midlines were compared to identify the most reliable one for symmetry assessments. A Python-based automated framework was created to calculate the analyses based on landmarks' x and y coordinates. Inter-observer and intra-observer reliability were assessed using Intraclass Correlation Coefficient (ICC) and Mean Absolute Deviation (MAD) metrics. Among the 5 midlines for symmetry analysis, the perpendicular of the interpupillary line passing through the glabella was found to be the most reliable. Overall, the analyses demonstrated relatively good reliability. However, certain landmark points, specifically Gonion (Go), Malar Eminence (ME), Zygion (Zy'), Frontotemporale (Ft'L), and Trichion (Tr'), exhibited lower reliability. Consequently, the reliability of specific analyses, including Bizygomatic width/Facial width, Nasal bridge width/ Endocanthions' distance, and horizontal symmetry of Go', N', and Zy' was reduced. This study presents a comprehensive collection of soft tissue landmarks, facial analyses, and their corresponding inter- and intra-observer reliability. Furthermore, the most reliable facial midline for symmetry analysis was determined. This study demonstrated that certain indices defined in three dimensions have lower reliability when drawn in 2-dimensional images, affecting the reliability of derived analyses.
This manuscript presents the transcript of the World Federation of Orthodontists Honorary Lecture delivered at the opening ceremony of the 10th International Orthodontic Congress in Rio de Janeiro, titled "My Long and Winding Road in Orthodontics." The lecture reflects on the author's professional journey in orthodontics and the evolution of the speciality over several decades, illustrated through representative clinical cases. The narrative traces major paradigm shifts in orthodontic practice, including the transition from banding to bonding, advances in anchorage control, the introduction of skeletal anchorage systems, the emergence of aligner-based therapies, and the integration of digital technologies into diagnosis and treatment planning. Clinical cases are presented to demonstrate how these developments have influenced treatment strategies for complex malocclusions, including vertical discrepancies, anterior open bite, severe skeletal deformities, and interdisciplinary orthodontic-surgical cases. Long-term follow-up records are included when available, emphasizing treatment stability and the enduring importance of accurate diagnosis and patient cooperation. Beyond technical advances, the lecture underscores the broader role of orthodontics in improving function, esthetics, and quality of life, while highlighting the values of mentorship, collaboration, and lifelong learning. This Honorary Lecture transcript is intended to offer inspiration and clinical insight to orthodontic students, residents, and practitioners by sharing lessons learned from a lifetime dedicated to the speciality.
Polymorphisms in the growth hormone receptor (GHR) gene influence the craniofacial system by affecting the growth of the mandibular body length and ramal height, with significant variations observed across different ethnic populations. This study investigated the relationship between a single nucleotide polymorphism (rs6184) in the GHR gene and its effects on mandibular morphogenesis in a Dravidian population. A total of 250 subjects were divided into three groups. Group 1 included 100 subjects with skeletal Class I malocclusion and average ramal height (control group). Group 2 included 150 patients with skeletal Class II malocclusions and reduced mandibular body length. On the basis of ramal height, group 2 was divided into two groups with 75 subjects each (short ramus: group 2a) and (long ramus: group 2b). DNA extracted from the salivary samples of individuals was analyzed to identify the genotype of the rs6184 using the polymerase chain reaction-restriction fragment length polymorphism method and compare it in the three groups. The genotype and allele frequencies showed statistically significant differences between the control (group 1) and groups 2a and 2b (P < 0.0001), with the polymorphic homozygous TT genotype found only in subjects with Class II malocclusions and reduced mandibular body length. However, no statistically significant difference was found between individuals with small and long ramal heights (group 2a and 2b, P = 0.7789). The rs6184 polymorphic variant of the GHR gene can be considered a candidate gene for mandibular morphogenesis in the Dravidian population.
The most common maxillary lateral incisor agenesis (MLIA) orthodontic management options are space closure or space reopening and implant placement. This study aimed to 1. Examine and compare the aesthetic evaluation patterns of orthodontists, dentists, and laypeople for ``good'' and ``bad'' cases of MLIA treated with space closure, space reopening, and implant placement; 2. Determine if ``good'' and ``bad'' cases were scored differently within each group; and 3. Investigate potential gender differences in aesthetic evaluations. A questionnaire was completed by 57 orthodontists, 75 dentists, and 85 laypeople. Participants ranked images of treated MLIA cases on a 1 to 10 scale and identified the best and worst outcomes. Nonparametric statistical analyses (Kruskal-Wallis, Friedman, and Mann-Whitney U tests) were employed for both descriptive and inferential analyses. Laypeople assigned statistically significantly higher ratings to ``bad'' images of both treatment modalities than orthodontists and dentists. Significant differences were found in the comparisons of `good' and `bad' images for both treatment types within the orthodontist and dentist groups. However, statistically significant differences were observed only among laypersons for space opening. Statistically significant sex differences were found among laypeople scoring ``bad'' cases for both treatment approaches. Dentists and orthodontists can differentiate between good and bad results of closed and open treatments, but laypeople only do so in open cases. Laypeople tend to assign better scores than orthodontists and dentists, and when they are men, they are less critical than women of unesthetic results.
Otological management in patients with cleft lip and/or palate has focused on early interventions such as ventilation tube placement. Improving palatal width and nasal airflow by maxillary expansion may enhance Eustachian tube function. Thus, we aimed to determine whether maxillary expansion therapy had any effect on hearing outcomes in cleft palate patients. Electronic searches employing defined keywords relevant to hearing impairment and maxillary expansion with no restriction on publication year or status, in adolescent nonsyndromic cleft patients were undertaken in PubMed, Scopus, Web of Science, Ovid MEDLINE, EBSCOhost, The Cochrane Library, LILACS, OpenGrey, and Google Scholar until January 15, 2025. Two authors on the Covidence software performed data extraction. The Methodological Index for Nonrandomized Studies and the Cochrane Risk of Bias tool were utilized to assess the risk of bias of the included studies. The search retrieved 68 studies, of which four studies finally met the inclusion criteria that included 158 patients with cleft and 26 non-cleft participants. The improvement in hearing threshold varied from 3 to 21 decibels (dB) in the included final studies. Pure tone audiograms and tympanometry were largely used by studies with variations across the types of expanders employed for maxillary expansion. The risk of bias varied from moderate to high risk. A preliminary analysis suggests that maxillary expansion may help improve hearing outcomes for patients with cleft palate, although the certainty of evidence by GRADE assessment was low to very low. More high-quality studies with randomized designs and extended follow-up are required to validate these conclusions and elucidate their clinical implications.
Systemic lupus erythematosus (SLE) is an autoimmune disease-causing inflammation. The impact of SLE pathology and treatment drugs on orthodontic treatment has not been closely examined. We report three cases of orthodontic treatment in patients with SLE. Patient 1: A 16-year-6-month-old female patient presented with an anterior crossbite. She had been receiving treatment with immunosuppressants, systemic steroids, and bisphosphonates (BP). Following BP withdrawal, the left maxillary deciduous canine was extracted, and she was treated with preadjusted edgewise appliances for 1 year and 2 months. Patient 2: A 33-year-4-month-old female patient presented with anterior crowding. She had been receiving immunosuppressive and systemic steroids treatment. After the withdrawal of immunosuppressants and administration of antibiotics, the maxillary and mandibular first premolars were extracted bilaterally, and she was treated with preadjusted edgewise appliances for 4 years and 4 months. Patient 3: A 24-year-9-month-old female patient presented with anterior crowding. She had been receiving immunosuppressants and systemic steroids treatment. The maxillary first premolars were extracted bilaterally under antibiotic coverage, and she was treated with preadjusted edgewise appliances for 2 years 11 months. In all cases, multidisciplinary approaches were employed, and favorable occlusion was established without SLE flare-ups. Although this report only involved three patients, the findings suggested the importance of starting orthodontic treatment during the remission phase of SLE, administering antibiotics prophylactically before tooth extraction, ensuring thorough oral hygiene management, and monitoring the morphology of the temporomandibular joint and root resorption. Further research is warranted to better understand the oral health of patients with SLE.
This case report presents a successful treatment of an 18-year-old male patient with skeletal open bite and mild dental crowding using clear aligners. The treatment plan involved a series of approaches: sequentially intruding the posterior teeth, extruding the maxillary anterior teeth, and implementing counterclockwise rotation of the mandibular plane and clockwise rotation of the occlusal plane to achieve desirable functional and esthetic outcomes. This comprehensive strategy resolved the anterior open bite and established Class I canine and molar relationships. After 2 years of treatment with a total of 64 (39 + 25) sets of clear aligners and a 1-year follow-up, all treatment objectives, including the resolution of open bite, proper alignment of teeth, mandibular repositioning, and improvement of lateral profile, were successfully achieved. This case demonstrates the effectiveness and advantages of clear aligners in treating anterior open bite. It not only provides a esthetically appealing and comfortable wearing experience, but also achieves remarkable outcomes in complex cases.
Passive, self-ligating lingual brackets are favored in Orthodontics for their simplified mechanism, eliminating the need for elastomeric and metallic ligatures. However, limited data exists on the effects of repeated use on their mechanical durability. An understanding of these effects is essential to ensure their long-term clinical performance. This study evaluates the mechanical degradation of the sliding cap locking mechanism of passive self-ligating lingual brackets after repeated opening and closing cycles. In this in vitro study, 60 ALIAS mandibular incisor brackets were subjected to repeated opening and closing cycles (5, 10, 20, and 40 cycles). Mechanical tests were performed using an Instron 3344 electronic universal testing machine to measure maximum force at failure (Fmax), energy absorption at Fmax (Umax), and initial stiffness of the bracket opening mechanism (K). The sliding cap remained functional throughout the test period. However, a significant reduction in Fmax, Umax, and K over multiple opening and closing cycles. Fmax showed a significant reduction after 5 opening and closing cycles (P = 0.0069), Umax after 10 cycles (P = 0.0243), and K showed after 5 cycles (P = 0.0002). The Fmax reached a plateau at about 8-10 Newtons after 10 cycles, Umax at about 2.0 mJ (millijoules), and K at 50 N/mm after 10 cycles. The study highlights significant advantages of passive self-ligating lingual brackets, showcasing their excellent initial performance. While ALIAS brackets may experience minor mechanical deterioration of the properties, their overall performance remains strong enough for entire duration of orthodontic treatment (2-3 years).
To investigate if chitosan nanoparticles (ChNPs), incorporated into three-dimensional-printed clear aligners (CAs), retain their antibiofilm activity against Streptococcus mutans after extended use in the oral environment. Additionally, to measure the impact of the aligners on patient-reported outcomes. Participants were randomly assigned to two groups: conventional CA and CA containing 3% ChNPs. They were instructed to wear their aligners for either one week (N = 16) or two weeks (N = 16) before CAs were retrieved. Clinical parameters, including plaque index (PI) and bleeding on probing (BOP), were measured, and the devices were weighed at baseline and at endpoints. A self-reported questionnaire was also completed. Samples from the retrieved devices underwent antibiofilm assays against S. mutans (American Type Culture Collection strain and a clinical isolate). After two weeks, the experimental group exhibited significantly lower PI and BOP scores compared to the control group (4.61 ± 1.22 vs 16.16 ± 5.26, and 3.83 ± 1.03 vs 5.35 ± 3.03, respectively). The number of colony-forming units was significantly reduced in the ChNPs-containing CAs (effect size > 0.9), with a greater effect against the American Type Culture Collection strain than the clinical isolate at both time points (effect size week 1: 0.953, week 2: 0.621). The ChNPs did not affect the device weight after in vivo aging, and the participants reported higher satisfaction levels. Three-dimensional-printed CAs with ChNPs retained strong antibiofilm activity against S. mutans after two weeks of in vivo use. This was clinically reflected by lower PI and BOP scores and improved self-reported outcomes.
To evaluate the cytotoxicity of direct 3D-printed aligners fabricated from Tera Harz TC-85DAC resin (TC) compared with conventional thermoformed aligners, and to investigate the effect of different post curing durations on TC cytotoxicity. Human gingival fibroblasts (HGFs) were exposed to eluates from TC and three thermoformed aligners (Essix ACE, Duran, Invisalign). TC aligners were postcured for 14, 20, and 40 minutes (TC80, TC100, TC200). Cell viability was assessed using the CCK-8 assay at 1, 3, 5, and 7 days, and cell migration was evaluated using a scratch wound healing assay at 24 and 48 hours. Statistical analysis was performed using ANOVA with Tukey's post hoc test. Cell viability was significantly reduced in the TC group compared with thermoformed aligners at days 3, 5, and 7. Cell migration was also significantly impaired in the TC group at 48 hours. Among TC subgroups, day-7 viability was significantly lower in TC80 compared with TC100 and TC200, whereas no significant differences in migration were observed among curing times. TC aligners significantly reduced cell viability over the 7-day incubation period compared to control and conventional thermoformed aligners. The cell migration was also significantly reduced in the TC group at 48 hours. Under-curing significantly decreased cell viability, whereas extending the post curing time beyond the manufacturer's recommendation did not result in additional improvement. Furthermore, the amount of cell migration across varying post curing durations was not different at both 24 and 48 hours.
This study aimed to evaluate the validity and usability of DentalMonitoring (DM), an Artificial Intelligence Driven Remote Monitoring (AIDRM) system, in providing standardized, high-quality photo sets that are clinically suitable for the visual assessment of various clinical parameters. Two independent prospective multi-centric investigations were conducted: The first, a usability investigation, included 63 patients from five sites in the United States. Its goal was to evaluate the usability of DM across four age groups, including individuals with physical disabilities. Patients provided subjective feedback through a questionnaire, while healthcare professionals conducted an objective evaluation of task performance. The second, a validity investigation, involved 104 patients from five other sites in the United States. This study aimed to compare the visual assessment of DM picture sets against the gold standard of standardized live assessments conducted by the same dental expert. Five clinical parameters per arch were evaluated, resulting in a total of 1,040 visual assessment parameters. In the usability investigation, most patients were able to achieve the steps with relative ease with no significant differences between types of participants. In the validity investigation, the global agreement between the two evaluations for the 1040 results generated for the five clinical parameters pooled was 98.9%. The study found that DM was user-friendly for all participants and that the photosets produced by the DM scans were substantially equivalent to the clinical live assessments conducted by dental experts. This suggests that DM is a highly reliable AIDRM tool, allowing healthcare professionals and patients to consistently produce high-quality image sets without requiring assistance or prior experience. This achievement opens the door to a new paradigm in orthodontic patient follow-up and may bring new dental prevention and treatment follow-up strategies.
This systematic review aims to assess whether extending Alt-RAMEC (Alternating Rapid Maxillary Expansions and Constrictions) protocols from four to nine weeks yields superior skeletal, dental, and soft-tissue outcomes in growing noncleft Class III patients when compared to conventional rapid maxillary expansion (RME). A systematic literature search was conducted across the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Scopus, Embase, Web of Science, Google Scholar, Ovid MEDLINE, EBSCOhost, and LILACS databases over the past 20 years up to 7 January 2025. Clinical trials comparing cephalometrically conventional RME with Alt-RAMEC-assisted maxillary protraction in growing noncleft Class III subjects were included. Risk of bias was assessed using the Methodological Index for Nonrandomized Studies (MINORS) and the Cochrane Risk of Bias (RoB 2) tool. A random-effects meta-analysis using RevMan was conducted for quantitative synthesis. Out of 1847 articles screened, 24 studies were included for qualitative synthesis and 11 studies for meta-analysis. The five-week Alt-RAMEC protocol showed a statistically significant improvement in the ANB angle compared to RME (mean difference 1.37°; 95% confidence intervals 0.85-1.89; P < 0.01; c2 = 2.14; I2 = 0%). However, both 7-week and 9-week protocols demonstrated no significant advantage over conventional RME/facemask. Only the five-week Alt-RAMEC protocol offers a statistically significant but clinically negligible improvement in maxillofacial, dental, and soft-tissue outcomes over conventional RME-assisted protraction in managing growing noncleft Class III malocclusion using a Hyrax-type expander. However, this is supported by only moderate to weak evidence.
Understanding the chief complaints of patients is essential for effective communication and successful orthodontic treatment. Although previous studies have often used structured questionnaires, few have applied data-driven methods to unstructured free-text responses. Furthermore, how these complaints from distinct semantic structures based on molar classifications remains underexplored. This study aimed to examine these structural differences using correspondence and co-occurrence network analyses. Patients who visited an academic dental hospital for an initial orthodontic evaluation between April 2011 and March 2024 were included. Data on chief complaints (free text), sex, age, skeletal classification, and molar classification were obtained from standardized diagnostic records. Chief complaints were analyzed structurally, retaining nouns and adjectives. We extracted the 60 most frequently used terms, followed by correspondence and co-occurrence network analyses. In total, 2568 (35.4% male) patients were included. Their mean age was 22.0 years (range: 7-74 years). Anterior esthetic concerns were the most frequently reported chief complaints across all patients. However, correspondence and network analyses revealed distinct structural patterns according to molar classification. Class I patients mainly cited esthetic reasons. Class II patients were characterized by morphological and symptomatic concerns and referrals. Class III patients presented interrelated skeletal, functional, and psychological concerns, often involving an awareness of surgical necessity and mentions of being pointed out by others. Although esthetic dissatisfaction is common, distinct complaint patterns exist based on molar classification. Recognizing these semantic structures facilitates shared decision-making and provides a foundation for developing patient-centered PROMs in orthodontic practice.