Background/Objectives: Contemporary patient-specific subperiosteal implants have re-emerged as graftless solutions for oral and maxillofacial rehabilitation, driven by advances in digital planning, CAD/CAM workflows, additive manufacturing, and biomaterial engineering. Their indications have progressively expanded from severely atrophic edentulous jaws to segmental defects, single-tooth replacement, congenital craniofacial anomalies, salvage situations, and oncologic reconstruction. This scoping review aimed to map the current evidence on modern patient-specific subperiosteal implants, focusing on indications, workflow, design principles, materials, outcomes, complications, and maintenance. Methods: A scoping review was conducted according to PRISMA-ScR principles to identify clinical studies, case series, case reports, systematic and scoping reviews, technical notes, finite element analyses, in vitro studies, and relevant translational investigations dealing with contemporary custom-made or CAD/CAM subperiosteal implants. The evidence was narratively synthesized according to clinical indication and thematic domains, including full-arch rehabilitation, sectional and single-tooth applications, congenital and post-oncologic defects, rescue indications, biomechanics, material selection, surface response, prosthetic protocols, and complication management. No quantitative meta-analysis was performed because of the scoping design and the substantial heterogeneity of study types, indications, implant systems, outcome definitions, and follow-up durations. Results: The final evidence map included 116 records, of which 56 were unique human clinical records with extractable denominators and 60 were biomechanical, in vitro, surface-biology, review, consensus, historical, or conceptual records. Of the 56 unique clinical records, 49 were mapped within the six indication-level clinical sections, while seven were retained as cross-cutting clinical evidence addressing patient-reported outcomes, design-related complications, bone apposition, anchorage strategy, comparative graftless rehabilitation, or reconstructive/prosthetic principles. The six indication-level sections included 52 clinical-record assignments: 15 for full-arch rehabilitation, 13 for segmental or sectional rehabilitation, one for single-tooth rehabilitation, four for congenital or craniofacial indications, 13 for post-oncologic or post-ablative reconstruction, and six for rescue or salvage indications. Because three records addressed more than one indication, these counts represent indication-level assignments rather than mutually exclusive clinical records. Reported survival in most short- to mid-term clinical series was generally high, commonly ranging from 90% to 100%, although lower values of 70-80% were reported in selected longer-term cohorts and survival clearly overestimated clinical success in some studies. Expanding applications include posterior mandibular and maxillary defects, lateral incisor agenesis, cleft-related or syndromic deformities, maxillectomy reconstruction, obturator support, and hybrid rehabilitation with endosseous implants; however, evidence for the indications at the extremes of this spectrum-single-tooth replacement and primary oncologic reconstruction-remains limited to small, largely single-group case series and reports. Soft-tissue events, including dehiscence, mucositis, recession, and framework exposure, were the dominant complications and showed wide variability, with reported recession/exposure rates ranging from approximately 10% in some sectional and full-arch series to as high as 65% in bilateral maxillary cohorts; their clinical significance varied from asymptomatic stable findings to progressive inflammatory complications requiring revision. Conclusions: Patient-specific subperiosteal implants represent a promising and increasingly versatile reconstructive option; however, the present findings should be interpreted as evidence mapping rather than as definitive comparative evidence. Their clinical use should remain highly selective, prosthetically driven, and supported by meticulous planning, rigid fixation, soft-tissue management, and structured maintenance. Standardized success criteria, longer follow-up, and comparative prospective studies are required.
The design of robotic graspers that can safely interact with deformable, damage-prone materials such as fruits, vegetables, and biological tissues remains an ongoing challenge in robotics. Conventional robotic graspers made of mostly rigid materials have limited compliance and tactile sensing, reducing their applicability to contact-rich manipulation of soft objects. In contrast, humans and animals can interact with their environments safely and intelligently through their bodies' structural properties and nervous systems' computational capabilities. In this article, we present the design and control of a soft grasper inspired by the sea slug, Aplysia californica, and compare its performance with rigid graspers. The soft jaws and actuators allow the grasper to mimic Aplysia's force sensing capability and its ability to conform to complex food as it grasps. Combining Synthetic Nervous Systems (SNSs), an artificial neural network model inspired by computational neuroscience, and network architectures inspired by Aplysia's feeding control circuitry, we designed distributed and interpretable pick-and-place controllers for the soft grasper and its rigid counterparts. During grasping, these controllers either command a fixed closure radius (feedforward position control) or cap the contact force at a predefined level (force feedback control). We first validated our approach in simulation, demonstrating that the controllers can perform pick-and-place behavior that is robust to sensor noise. We then extended the validation to the physical platform to quantitatively compare how much deformation these graspers induced on soft objects. Fruits such as strawberries, tomatoes, and avocados showed little deformation after they were handled by the soft grasper, suggesting that this approach might have significant agricultural uses. The experimental data suggest the value of the bioinspired soft grasper for soft object manipulation.
This study aimed to evaluate the accuracy of robotic computer-assisted implant surgery in edentulous patients and to compare differences in accuracy between implants placed in the maxilla and mandible, as well as between anterior and posterior regions. Six patients who voluntarily underwent autonomous robotic computer-assisted implant surgery (R-CAIS) using the YaKebot system and met the eligibility criteria were included in this study. Preoperative planning data and postoperative CBCT images were imported into the robotic software system for registration to calculate deviations between the designed and actual implant positions. The primary outcomes included global deviations at the implant platform and apex, angular deviation, as well as horizontal and vertical deviations at the platform and the apex. Deviations were compared among implants placed at different anatomical locations, with p < 0.05 considered statistically significant. Six edentulous patients underwent R-CAIS with a total of 42 implants placed. The mean deviation at the implant platform was 0.519 ± 0.216 mm, while the mean apex deviation was 0.508 ± 0.224 mm. The mean angular deviation was 0.634 ± 0.402°, and the mean vertical deviation was 0.298 ± 0.248 mm. The results showed that global deviations at the apex, global angular deviations, and platform vertical deviations tended to be lower in the anterior region than in the posterior region. However, none of these differences reached statistical significance (all p-values > 0.05). Implants in the maxilla exhibited overall smaller deviations than those in the mandible. Notably, the buccolingual deviation at the apex was significantly lower in the maxilla than in the mandible (p = 0.021). No other significant differences were found between the two jaws (all p > 0.05). In terms of deviation direction, the implants tended to deviate toward the buccal and distal directions and were positioned slightly more superficially than designed. R-CAIS can achieve high accuracy in implant placement in edentulous patients, supporting its broader clinical application in complex implant rehabilitation.
Background: Odontogenic keratocysts are developmental cysts of the jaws that often remain asymptomatic until they reach considerable size and are most frequently located in the mandibular angle and ramus regions. Due to their high recurrence potential, the optimal treatment approach remains controversial. The aim of this study was to evaluate treatment modalities associated with lower recurrence rates in odontogenic keratocysts. Material and Methods: Patients diagnosed with odontogenic keratocyst between 2000 and 2024 at the Department of Oral and Maxillofacial Surgery, Gazi University, were retrospectively evaluated. Associations between gender, age, lesion localization, histological subtype, treatment modality, and recurrence were analyzed. Statistical analyses were performed using SPSS for Windows (version 27). Results: A total of 291 cases were included, with an overall recurrence rate of 16.2%. The highest recurrence rate was observed in patients treated with enucleation (19.2%), whereas a lower recurrence rate was found in cases treated with marsupialization (5%). No recurrence was observed in patients who underwent resection. A statistically significant association was found between treatment modality and recurrence (p = 0.014). Conclusions: Treatment selection for odontogenic keratocysts should be carefully planned. In the present study, marsupialization was associated with a lower recurrence rate than enucleation in selected cases. However, because of the retrospective design and non-randomized treatment allocation, these findings should be interpreted with caution and should not be considered evidence of a causal relationship. Long-term clinical and radiological follow-up remains essential because of the potential for late recurrence.
Quality assurance (QA) in radiation therapy is a critical component of ensuring accurate and consistent patient treatments, but many tasks are time consuming and rely on human visual acuity, which limits their accuracy. We aimed to automate monthly mechanical QA tests, improve measurement accuracy and precision, and decrease inter-user variability using a computer vision-based quality assurance (CVQA) system. A custom marker board incorporating four ArUco markers was created along with a custom camera holder that mounted onto the gantry head. OpenCV was utilized to automate tests for couch translation, collimator and table angles, collimator and table walkout, optical distance indicator (ODI), and field size detection. A GUI was created to guide users through the tests, determine passing status of measurements based on MPPG8.b criteria, and display image captures to allow users to troubleshoot if needed. Reproducibility tests were taken across four days. The system was tested against manual measurements by graph paper or digital level for each test. Field sizes and ODI were read by 12 different physicists to determine human variability and comparisons for CVQA. The CVQA system took 5 min to set up and 7 min to perform all tests. All field sizes, collimator/table angles, collimator/table walkout, and table translations were reproducible within 0.5 mm and 0.5°. ODI measurements were reproducible within 1 mm. Table travel, ODI, and walkout measurements agreed with manual measurements within 0.5 mm and 0.4°, except for vertical table motions that agreed within 0.9 mm due to the lens focus being optimized for the 100 cm SSD plane. The standard deviation between physicists for almost all symmetric and asymmetric jaws was larger than the reproducibility of CVQA. CVQA has been utilized for five years and has demonstrated ability to identify mechanical machine issues. CVQA successfully automates mechanical QA tasks, providing an efficient and precise system. CVQA is open source and freely available for academic institutions. Its adoption can improve workflow efficiency and consistency in clinical environments.
To investigate, using micro-computed tomography (micro-CT), the apical anatomy of mandibular second primary molar roots in Egyptian children, with emphasis on the spatial relationship between the apical foramen and the anatomic apex, and the morphology and dimensions of the root canal at the apical foramen level. Fifty extracted human mandibular second primary molars (150 canals: 50 distal, 50 mesiobuccal, 50 mesiolingual) with complete root length and minimal resorption were scanned using high-resolution micro-CT (15.24 μm voxel size). The distance between the apical foramen and the apex, canal major diameter, and roundness at the foramen level were measured using CTAn software. Descriptive statistics were calculated, and exploratory canal-type comparisons were performed using one-way ANOVA followed by Tukey post-hoc tests. (α = 0.05). The apical foramen did not coincide with the anatomic apex in any canal. The mean apex-to-foramen distance was 0.57 ± 0.44 mm. Mean apical canal diameter was 0.63 ± 0.24 mm and mean roundness was 0.48 ± 0.17, indicating predominantly oval canal shapes. The overall comparison suggested variation in apex-to-foramen distance among canal types (p = 0.040), but post-hoc comparisons did not confirm statistically significant pairwise differences between individual canal types. Distal canals exhibited significantly larger diameters than both mesial canals (p < 0.05), whereas the difference between mesiobuccal and mesiolingual canals was not significant. Roundness did not differ significantly among canal types (p = 0.079). In Egyptian children, the apical foramen of mandibular second primary molar is consistently offset from the anatomic apex. The distal canals demonstrated the largest major canal diameter at the apical foramen level. Because the apical foramen rarely coincides with the apex and complete mechanical enlargement to the true apical diameter is often clinically unrealistic, pediatric endodontic treatment should prioritize accurate working-length determination (e.g., electronic apex locators) and combine conservative shaping with effective chemical disinfection to optimize apical cleaning while preserving root integrity.
This study aimed to determine the extent and trajectory of enamel caries from adolescence through young adulthood and the associated factors. Data were from the first and third Fit Futures (FF) studies that followed a cohort of Norwegians from the first year of upper secondary school (FF1 2010-2011, age 17) for 10 years (FF3 2021-2022, age 27). Participants answered questionnaires and underwent clinical dental examinations. The study sample included participants with data on caries and restorations at both ages 17 and 27 (N = 584, 53% of the original FF1 cohort, 53% women). Data were analysed using descriptive statistics, and associations between risk factors and caries activity were examined using regression models. Almost all participants had enamel caries lesions (median 12.0 and 9.0 lesions at ages 17 and 27, respectively), and 64% had lesions that had progressed into dentin during the observation period. At the tooth surface level, 10% of all surfaces had enamel caries at age 17, of which 18% had progressed to dentin caries by age 27. The highest progression rates were observed on proximal surfaces and for premolars of the upper jaw. In regression analyses, high caries activity was associated with female sex, low socioeconomic status, poorer self-reported general health, poor oral hygiene habits, and high soft drink intake. Enamel caries lesions were almost ubiquitous, but more than 80% did not progress over a 10-year period, lending strong support to nonoperative treatment of such lesions. Nevertheless, the study demonstrated relatively high caries activity during the transition from adolescence to adulthood and underlines the importance of dietary guidance and oral hygiene motivation to prevent caries. Having medium or low socioeconomic status and facing general health issues should also be considered important caries risk factors.
Le Fort I osteotomy is widely performed in orthognathic surgery for maxillary repositioning and for the treatment of dentofacial deformities and obstructive sleep apnea (OSA). Postoperative relapse remains a concern, particularly after large maxillary advancements, highlighting the importance of rigid fixation. This study aimed to determine which fixation technique provides the greatest rigidity. In this in vitro study, the biomechanical rigidity of five commonly used fixation techniques for Le Fort I osteotomies was evaluated using 150 polyurethane specimens with advancements of 5 mm and 10 mm. The techniques included two L-plates (A), four L-plates of different thicknesses (B and C), two precontoured Le Fort I plates (D), and a hybrid configuration with two precontoured Le Fort I plates combined with two L-plates (E). Resistance to vertical displacement was measured at 1, 3, and 5 mm using a biomechanical testing machine. Fixation E consistently showed the highest resistance across both advancement distances and all displacement intervals, significantly outperforming fixations A, C, and D. Fixation B demonstrated resistance comparable to fixation E, whereas fixation C showed inferior performance despite a similar configuration. Fixations A and D showed the lowest resistance, particularly at 10 mm advancement. Overall, fixation E provided the greatest rigidity, while techniques relying on only two plates were biomechanically less effective. Further clinical studies are required to determine the clinical relevance of these findings.
The diagnosis of primary bone tumours of the jaw often presents as a diagnostic dilemma. Overlap in clinical, radiological, and histological features between benign lesions like juvenile trabecular ossifying fibroma (JTOF); osteoblastoma (OB) and malignant tumours like low-grade osteosarcoma (LGOS) makes the diagnosis challenging. While osteosarcoma is a malignant tumour with poor prognosis requiring aggressive treatment, benign lesions have generally favourable outcome. This study aimed to assess the immunohistochemical expression of murine double minute 2 (MDM2) and Cyclin-dependent kinase 4 (CDK4) in low-grade osteosarcoma and benign osseous lesions. Immunohistochemical analysis was performed on tissue samples from diagnosed cases of LGOS, JTOF, and OB. The expression levels of MDM2 and CDK4 were analysed and compared across the three groups. We found significantly higher expression of MDM2 and CDK4 in low-grade osteosarcoma compared to JTOF which showed negative expression in all of the cases. Osteoblastoma showed inconsistent and focal positivity contrary to OS where strong and diffuse expression of both the markers was observed. A strong co-expression of both the markers was also noted in 94% of OS cases. Immunohistochemistry for MDM2 and CDK4 is a valuable diagnostic tool in differentiating low-grade osteosarcoma from benign mimics. This approach provides a cost-effective, reliable, and accurate means for diagnosing jaw bone tumours, particularly when tissue samples are insufficient or on small incisional biopsies where accurate diagnosis is of prime importance.
Factors associated with sleep bruxism (SB) in children with mixed dentition remain incompletely understood. This study examined the relationship between sleep bruxism and sleep behaviors, oral habits, temporomandibular disorders (TMD), and health status in Turkish schoolchildren during the mixed dentition stage. In this cross-sectional study, a representative sample of 452 schoolchildren was assessed. Sleep bruxism was assessed by a subjective-based assessment (parental report of tooth grinding during sleep). During the clinical oral examination, tooth wear, free-way space, maximum mouth opening, and signs of TMD were recorded. Parents or caregivers completed a questionnaire on sociodemographic factors, general health, sleep behavior, oral habits, and recent life changes. Associations were analyzed using the χ² or Fisher's exact test, the Mann-Whitney U test, and logistic regression, with effect sizes (Cramér's V, odds ratios, and r). Sleep bruxism was identified in 22.6% of the 452 children, with no significant difference between genders (p = .077). Regarding health status, SB was more common among children with allergic rhinitis (p < .001; OR = 2.42, 95% CI 1.50-3.91). Regarding TMJ/jaw function and oral habits, SB was associated with head/jaw trauma, difficulty opening the mouth, TMJ pain, pain while chewing hard foods, biting hard foreign objects, chewing hard candies or ice, and leaning the jaw against the hand (all p < .05). Regarding sleep-related variables, SB was associated with snoring, drooling on the pillow, bedwetting, restless sleep, and mouth-breathing (all p < .05). Regarding family factors, SB was associated with parental and sibling grinding and with parental divorce (all p < .05). TMD symptoms were present in 22.5% of bruxism-positive children compared with 12.3% of bruxism-negative children (p = .010; OR = 2.08, 95% CI 1.18-3.65); all effect sizes were small (Cramér's V ≤ 0.21). No significant association was found between SB and tooth wear (p = .282). In multivariable analysis, allergic rhinitis, parental history of grinding, drooling on the pillow, restless sleep, and TMD remained independently associated with SB. Sleep bruxism was associated with several sleep-related, respiratory, behavioral, and family-history factors and with TMD signs and symptoms, although all associations were of small magnitude. After multivariable adjustment, allergic rhinitis, parental history of grinding, drooling on the pillow, restless sleep, and TMD were independently associated with SB. Given the cross-sectional design, these findings indicate associations rather than causal or aetiological relationships. Approved by the Ethics Committee of Dokuz Eylul University (2024/13-18).
Pulmonary arterial hypertension (PAH) is a rare, progressive disorder characterized by pathological pulmonary vascular remodeling leading to right heart failure. Ralinepag extended-release (XR), is a once-daily oral prostacyclin (IP) receptor to treat PAH. This study evaluated the safety, tolerability, and pharmacokinetics (PK) of multiple ascending doses of ralinepag XR tablets in fed and fasted healthy adult volunteers. A single-center, open-label, nonrandomized, multiple-dose titration study of two cohorts (fed (n = 13) or fasted (n = 15)) with once-daily dosing of ralinepag XR for 5 days, with up to four sequential dose escalations. Dosing began at 60 µg and escalated every 5 days as tolerated (120, 180, 240, and 300 µg). Doses were administered after a 10-h overnight fast or a moderate-fat breakfast. PK parameters assessed were maximum observed concentration (Cmax), area under the concentration-time curve from time 0 to 24 h postdose (AUC(0-24)), and time of maximum observed concentration (Tmax) on day 1 (single 60 μg dose); and Cmax, AUC(0-24), and Tmax at steady state. Ralinepag XR exhibited minimal differences in PK parameters between fed and fasted states in the first 24 h. Multiple-dose administration showed a dose-dependent increase in exposure and a median 4-10 h Tmax at steady state, independent of fed status. Ralinepag accumulation was approximately 2.1-fold after 5 days of dosing at 60 μg in both fed and fasted states, consistent with a mean half-life of 20-36 h. There were no serious adverse events attributable to ralinepag. The most commonly reported adverse events were headache, jaw pain, and nausea with no differences between groups. Food status did not significantly affect the PK or safety of ralinepag XR.
Background/Objectives: The aim of this study was to assess the diagnostic capabilities of three large language model-based artificial intelligence chatbots (ChatGPT 4.0, Gemini 2.5, and Microsoft Copilot) in the radiographic evaluation of jaw lesions on panoramic images with different densities (mixed, radiolucent, and radiopaque). Methods: 120 panoramic radiographs showing jaw lesions with varying radiographic appearances were independently analyzed using three artificial intelligence chatbot systems. Each model was provided with the same single-round prompt and a standardized diagnostic scoring framework encompassing lesion structure, configuration, border characteristics, morphology, relationship with teeth, effects on adjacent structures, biological behavior indicators, and total diagnostic scores. Descriptive statistics were reported as mean ± standard deviation and median (minimum-maximum). Differences between LLM scores were analyzed using the Kruskal-Wallis test, followed by Bonferroni-corrected post hoc comparisons. The statistical significance level was set at p < 0.05. Results: Significant differences were observed among the LLMs across multiple diagnostic categories, including lesion structure, configuration, border characteristics, and total scores (p < 0.05). Gemini achieved the highest total scores in radiolucent (11.49 ± 4.97) and mixed lesions (9.01 ± 5.78), whereas ChatGPT showed slightly higher performance in radiopaque lesions (10.93 ± 2.88). Copilot demonstrated the lowest overall performance across all lesion categories. Conclusions: Large language model-based artificial intelligence chatbots showed variable performance in the panoramic radiographic evaluation of jaw lesions with radiolucent, radiopaque, and mixed patterns, suggesting potential utility as supportive tools. However, further validation studies are required before routine clinical implementation.
The structural integrity of teeth after endodontic retreatment depends on the amount of remaining dentin. Excessive instrumentation can weaken roots and predispose them to fracture. This study evaluated the fracture resistance of maxillary premolars following non-surgical retreatment (NS-ReT) with Retreaty and XP-endo Rise systems. Forty-eight maxillary first premolar roots were randomly assigned to 4 groups (n = 12); G1-NC (Negative control, non-instrumented), G2-PC (Positive control, instrumented, not obturated), G3-RETY (Retreaty), and G4-XPER (XP-endo Rise). G2, G3 and G4 groups were prepared using the iRace system. Groups G3 and G4 were obturated with gutta-percha and resin sealer. Gutta percha removal was performed using Retreaty (G3-RETY) and XP-endo Rise retreatment files (G4-XPER). All samples were subjected to fracture testing using a universal testing machine & the maximum fracture load (N) was recorded. Gutta percha removal times (Tf) and total time of retreatment were also measured. Statistical analysis was performed using a mixed-model analysis of variance (ANOVA) (α = 0.05). The fracture resistance of G1-NC (942.92 ± 24.73 N) had significantly higher values compared to all other groups. Fracture values for the G2-PC (829.62 ± 71.55 N) and the G3-RETY (818.29 ± 73.14 N) did not significantly differ from each other (p = 1.000), but both were significantly higher than the G4-XPER (489.37 ± 33.47 N). The total time of retreatment was significantly reduced when using the G3-RETY (3.89 ± 0.84 min) compared to the G4-XPER (13.30 ± 2.05 min), p < .001. Teeth retreated using the Retreaty instruments demonstrated superior fracture resistance compared to XP-endo Rise and their values were comparable to the positive control group. Moreover, Retreaty file system showed faster gutta-percha removal and canal preparation during retreatments.
To characterize invasive dental procedures in romosozumab-treated osteoporosis patients and describe medication-related osteonecrosis of the jaw (MRONJ) according to exposure timing. This retrospective study used electronic medical records and prescription/administration data from Yonsei University Dental Hospital between 2019 and 2024. Participants who received romosozumab, underwent tooth extraction and/or implant placement, and had at least 6 months of follow-up were included. Invasive dental procedures were categorized according to the timing of romosozumab administration relative to dental treatment (before, after, or both before and after treatment). MRONJ was identified according to American Association of Oral and Maxillofacial Surgeons criteria. Analyses were descriptive. A total of 201 participants underwent 303 invasive procedures (231 extractions, 72 implants). Extractions were most commonly performed for retained root (30.3%), caries (22.1%), periodontal disease (19.0%), and fractures (11.7%). Among the procedures, 77 (25.4%) were categorized as before dental treatment, 182 (60.1%) as after dental treatment, and 44 (14.5%) as before and after dental treatment relative to romosozumab administration. One case of MRONJ occurred in a participant with sequential exposure to denosumab, romosozumab, and subsequent intravenous zoledronic acid therapy, accompanied by local infection. A causal relationship with romosozumab monotherapy could not be determined because MRONJ occurred during cumulative and sequential antiresorptive exposure with local infection. Larger studies are needed to assess risks related to treatment sequence and cumulative exposure. Clinicians managing patients receiving romosozumab should consider cumulative antiresorptive exposure, local infection, and close coordination between physicians and dentists.
This study aimed to investigate sex differences in age-related changes to the dentoskeletal and soft tissue profile between 12-62 years of age using a superimposition-based cephalometric method. A total of 60 subjects (27 males and 33 females) were followed longitudinally. Lateral cephalograms were obtained at ages 12 (T1), 15 (T2), 30 (T3), and 62 (T4). Of note, 46 angular and linear cephalometric variables were measured using a cranial base-registered superimposition method that corrected for age-related displacement of the Nasion and Sella landmarks. Sex differences in changes between time points were analyzed using independent-samples t tests. During adolescence (12-15 years of age), males exhibited greater sagittal advancement of the maxilla and mandible, as well as larger increases in facial height and jaw dimensions compared with females. Between 15-30 years, sexual dimorphism peaked: males showed anterior mandibular rotation accompanied by increased mandibular protrusion, whereas females exhibited mandibular incisor proclination and reductions in the nasolabial angle and lip protrusion. After the age of 30 years, maturational trajectories converged, with both sexes showing posterior mandibular rotation and retroclination, retursion of maxillary and mandibular incisors, and similar soft-tissue changes. Sex-specific growth patterns are most pronounced during adolescence and young adulthood but diminish after the third decade. Soft tissue profile changes tend to occur earlier in females. The age-related reduction in incisor and lip prominence, particularly among females, should be taken into consideration when planning orthodontic, prosthodontic, and orthognathic treatments.
To evaluate dental and skeletal factors influencing spontaneous space closure and axial angulation of the second molar (P2M) and second premolar (SP) five years after permanent first molar (P1M) extraction. This retrospective cohort study included 79 patients (mean age 9.5 ± 1.6 years) with unilateral P1M extraction. Panoramic radiographs were analyzed at T1 (pre-extraction) and T2 (5-year follow-up). P2M developmental stages (Demirjian), initial vertical positions, and baseline skeletal parameters (gonial angle, condylar inclination, and antegonial notch angle) were assessed on T1 panoramic radiographs. Angulation changes were compared between the extraction and the non-extraction control sides. Complete space-closure status did not differ significantly among Demirjian developmental stages (p > 0.05). In the maxilla, P2M angulation changes differed significantly among developmental timing groups (p = 0.018). In the mandible, SP showed significant distal tipping within all developmental groups (p < 0.05), whereas no significant SP angulation change was observed in the maxilla. A significant positive correlation was identified between baseline antegonial notch angle and complete space closure (p = 0.011). Compared with the contralateral non-extraction side, the extraction side showed significant angular differences for both P2M and SP. The P2M developmental stage alone appeared insufficient for explaining complete space closure following unilateral P1M extraction. Post-extraction angular changes differed according to jaw and tooth type, and baseline antegonial notch angle showed an exploratory association with complete space closure. These findings suggest that selected panoramic observations may provide supplementary information during case assessment, but should not be interpreted as standalone predictive criteria. In children requiring P1M extraction, P2M developmental stage should not be used as the sole criterion for estimating spontaneous space closure. Expected post-extraction tipping patterns and selected panoramic findings, particularly the antegonial notch angle, may provide supplementary information during case assessment.
Background/Objectives: Declining masticatory function affects dietary variety, nutritional status, cognitive function, and health. Although factors related to chewing ability have been reported, the causes of temporal changes in masticatory kinematics in older adults remain unclear because prospective longitudinal data remain limited. Objectives: This follow-up study investigated factors associated with changes in masticatory movement in older adults requiring long-term care. Methods: Participants were 42 older adults residing in long-term care facilities. Survey items included mandibular kinematic data during rice cracker chewing and variables related to chewing, and the same assessment was performed two years after baseline. Relationships between changes in masticatory movement and other variables were examined, and factors associated with masticatory movement were identified using a linear mixed model (LMM). Results: A change in the number of cycles was significantly associated with the rate of change in the appendicular skeletal muscle mass index (ASMI). The rates of change in the number of linear motions and circular motion frequency were significantly associated with changes in the ABC Dementia Scale (ABC-DS). In the LMM results, cycle frequency remained associated with ASMI after adjustment for confounding factors, and both the number of circular motions and circular motion frequency were associated with ABC-DS. Conclusions: The findings suggest that masticatory movement in older adults requiring long-term care is influenced by skeletal muscle mass and cognitive function. In care facilities, interventions to maintain these factors are essential to help prevent dietary texture modifications among residents, while supporting nutrition, oral function, and health in this population.
Haploinsufficiency of SKI, PRDM16, RERE, PAX7, and GRHL3 have been implicated in the development of orofacial clefting (OFC) associated with chromosome 1p36 deletions based on human and/or mouse data. Haploinsufficiency of SPEN, a 1p36 gene that encodes a transcriptional repressor, causes Radio-Tartaglia syndrome, a neurodevelopmental syndrome in which high/narrow palates are common, and OFC is occasionally observed. We show that Spen-null embryos have abnormal palatal shelf elevation and extension leading to the development of cleft palate. Mesenchymal cell proliferation in the medial halves of the palatal shelves of Spen-null embryos at E13.5 is significantly reduced. This contributes to the delay of palatal shelf elevation. Tissue specific ablation of Spen in the cranial neural crest cells results in delayed palatal development. This pattern of abnormal palatal development mimics the pattern described in RERE-deficient mice. We show that Rere and Spen are expressed in same cell types, that Rere and Spen interact genetically in the development of the palate, that Spen expression is reduced in the palates of RERE-deficient embryos at E14.5, and that the rate of OFC in individuals with 1p36 deletions involving both RERE and SPEN is higher than those of individuals with RERE or SPEN haploinsufficiency. Our results suggest that SPEN is required for normal mammalian palatal development, that RERE and SPEN interact in a common pathway during palatal development, and that haploinsufficiency of RERE and SPEN are likely to contribute to the development of OFC in individuals with 1p36 deletions.
Complete arch implant scanning with an intraoral scanner (IOS) immediately after implant placement is challenging because of blood, saliva, and mobile soft tissues. It remains unclear whether oriented horizontal implant scan bodies (ISBs) can maintain accuracy under these conditions compared to stable laboratory scans. The purpose of this clinical study was to assess the accuracy of immediate intraoral scans using oriented horizontal ISBs after complete arch implant placement and compared them with scans of corresponding stone casts under laboratory conditions. Participants receiving complete arch implant placement were included. Immediately after surgery, 2 recordings were obtained: an intraoral digital scan (immediate IOS) using oriented horizontal ISBs (ioConnect), and a conventional open-tray splinted impression. Stone casts from the conventional impressions served as the reference. The same ISBs were attached to the reference cast and scanned to generate the laboratory IOS dataset. Immediate and laboratory IOS datasets were superimposed on the reference cast using a standardized protocol. Four accuracy metrics were analyzed: root-mean-square (RMS) surface deviation, linear Euclidean deviation, angular deviation, and interimplant distance deviation. A 2-way mixed-effects ANOVA was used, with scanning workflow (immediate versus laboratory) as a within-subject factor and jaw type (maxilla versus mandible) as a between-subject factor (α=.05). All measurements were performed by a single calibrated examiner. Twenty participants (20 arches) were analyzed. Laboratory IOS showed significantly lower deviations (higher trueness) than immediate IOS. RMS deviation was 0.043 ±0.017 mm for immediate IOS versus 0.030 ±0.017 mm for laboratory IOS (P=.002). Linear Euclidean deviation was 0.062 ±0.031 mm versus 0.036 ±0.020 mm (P<.001), and interimplant distance deviation was 0.071 ±0.047 mm versus 0.052 ±0.031 mm (P=.020). Angular deviation did not differ significantly (0.577 ±0.458 degrees versus 0.533 ±0.394 degrees, P=.399). Jaw type had no significant effect (P>.05). Immediate IOS with oriented horizontal ISBs showed reduced linear and surface trueness compared to laboratory IOS, but overall accuracy remained within clinically acceptable limits for immediate complete arch rehabilitation.
Importance: Vertical maxillary excess (VME) is a common dentofacial deformity that causes downward growth of the maxilla, leading to an elongated lower face, anterior open bite, and excessive gingival display. Although conventional Le Fort I osteotomy remains the gold standard for correcting vertical maxillary excess, it is associated with certain risks, including possible injury to the descending palatine artery (DPA). To improve surgical safety and treatment predictability, several modified osteotomy techniques have been introduced. To systematically review and compare the clinical effectiveness, postoperative stability and safety of modified Le Fort I osteotomy techniques in treating VME. Data Sources: A systematic search was conducted using PubMed, Medline, Google Scholar, and Web of Science databases for studies published between 2016 and 2024. The review protocol was registered with PROSPERO (CRD42025616635). Studies involving adults with vertical maxillary excess (VME) were included. Eligible studies evaluated modified Le Fort I osteotomy techniques-specifically conventional horseshoe, modified horseshoe, unilateral horseshoe, pyramidal, or U-shaped osteotomies-in patients undergoing orthognathic surgery. A total of 10 studies comprising 117 patients met the inclusion criteria. Data extraction and synthesis were performed systematically to obtain information regarding surgical techniques, intraoperative and postoperative complications, maxillary repositioning accuracy, and long-term stability outcomes. Given the methodological and clinical heterogeneity among the included studies, a qualitative synthesis of the findings was undertaken. Primary outcome measures included successful maxillary repositioning, intraoperative or postoperative complications (particularly vascular injuries), and skeletal stability over at least one year. Results: The electronic search identified 1,190 articles, of which 10 studies met the inclusion criteria. All reviewed modified Le Fort I techniques achieved intended repositioning without major complications. Notably, there were no significant vascular injuries, and skeletal stability was maintained for at least 12 months. Conclusion and Relevance: Modified Le Fort I osteotomies represent safe and effective alternatives to traditional methods, reducing risks while ensuring stable outcomes. Tailoring techniques to individual patient needs is crucial for optimizing aesthetic and functional results in VME management, ultimately improving patient satisfaction and quality of life. PROSPERO (CRD42025616635).