European journal of orthodontics最新文献

Background: Individuals with dentofacial deformities (DFD) present several orofacial myofunctional alterations. However, the characteristics of tongue position and motor performance, which are crucial for DFD assessment and treatment, remain poorly understood.

Objectives: To assess orofacial myofunctional status and analyze tongue position, mobility, behavior during swallowing, and pressure/strength performance in patients with Class II and Class III DFD compared with control subjects, as well as to formulate a tongue functionality index.

Methods: Fifty-six patients with DFD were divided into two groups: Class II DFD (CII, n = 26) and Class III DFD (CIII, n = 30). Nineteen healthy individuals composed the control group. All participants were evaluated using the Orofacial Myofunctional Evaluation with Scores (OMES) protocol and the Iowa Oral Performance Instrument (IOPI) for tongue strength measurements. The tongue functionality index was obtained by summing the z-scores of the total tongue score and saliva-swallowing strength.

Results: Patients with DFD showed lower total OMES scores (indicating worse performance), lower tongue performance scores, and reduced tongue strength during swallowing (P < .01). The tongue functionality index demonstrated excellent diagnostic accuracy and sensitivity, as well as good specificity, in differentiating the tongue status of patients with and without DFD.

Conclusion: The individuals from groups CII and CIII exhibited global orofacial myofunctional alterations, impaired tongue position and motor ability, and reduced tongue strength during swallowing. The tongue functionality index may serve as a useful variable for predicting tongue functional status.

Objective: This study compares the surgery-first approach (SFA) and the conventional orthognathic approach (COA) in terms of total treatment duration and complications in patients with skeletal malocclusions.

Methods: A retrospective analysis was conducted on 34 patients treated at Helsinki University Hospital, with 17 patients in each treatment group. The groups were matched by age, sex, and type of surgery. Treatment duration was assessed using statistical comparisons, and perioperative and postoperative complications were analyzed using logistic and Poisson regression models adjusted for age, sex, and surgery type.

Results: SFA significantly reduced the total treatment duration compared to COA by eliminating the presurgical orthodontic phase (13.0 months vs. 27.67 months, P = 1.66×10-10). The groups were similar in terms of their difficulty scores according to the ICON scale (P > 0.05). However, the postsurgical orthodontic phase was significantly longer in the SFA group (11.72 months vs. 8.22 months, P = 6.18×10-13). Maxillary retrognathia was independently associated with a shorter total treatment duration, while open bite prolonged postsurgical orthodontic treatment, regardless of the surgical approach. Age was the only significant predictor of complications (P = 0.042), with older patients being at a greater risk.

Conclusions: SFA is an effective alternative to COA, offering a shorter overall treatment duration while requiring longer postsurgical orthodontic management. While complication rates do not significantly differ between the approaches, older patients are at a higher risk of complications.

Aim: To record reporting of harms by authors of randomized controlled trials (RCTs) in indexed orthodontic journals of the Q1 ranking, and explore associations between published reports and several publication characteristics.

Materials and methods: RCTs from six (6) Q1 indexed orthodontic journals, namely the American Journal of Orthodontics and Dentofacial Orthopedics (AJODO), the European Journal of Orthodontics (EJO), the Angle Orthodontist (ANGLE), Progress in Orthodontics (PIOR), the Korean Journal of Orthodontics (KJO), and the Journal of the World Federation of Orthodontists (JWFO) from January 2020 to December 2024 were included. Data extraction was conducted for outcome and predictor variables such as reporting of harms or otherwise, and other publication characteristics including year of publication, journal, origin of authorship, number of authors, design of the RCT, registration, funding, reporting of patient reported outcome measures (PROMs). Statistical analyses included descriptive statistics, cross-tabulations, and univariable and multivariable logistic regression.

Results: A total of 183 RCTs were included. Twenty four percent of RCTs (44/183) did not report on harms in their publications. A significant association was detected between reporting of harms and journal of publication, with EJO published studies acknowledging pertinent harms almost in their entirety (49/51; 96.1% reported harms; P = .008). RCTs of American affiliated authors were the least likely to report harms (P = .02). Studies reporting on PROMs showed 2.73 higher odds for reporting harms compared with those that did not include PROMs (adjusted odds ratio, OR: 2.73; 95% CI: 1.04, 7.15; P = .04). There was strong evidence that RCTs with registered protocols presented higher odds for reporting harms than nonregistered trials (adjusted OR: 3.68; 95% CI: 1.62, 8.36; P = .002).

Conclusions: Albeit progress has been made, a quarter of orthodontic RCTs still do not include harms in their assessment. Registration, inclusion of PROMs, origin of authorship and journal of publication were significant predictors of harms reporting.

Objective: This cross-sectional study aimed to compare head and neck posture, hyoid bone position, and nasal and pharyngeal airway dimensions between orthodontic patients diagnosed with pediatric obstructive sleep apnea (OSA) and those with no risk of OSA.

Materials and methods: OSA group included 35 individuals (mean age = 12 ± 2.1 years; 16 female, 19 male) with an apnea-hypopnea index (AHI) greater than 1 confirmed via polysomnography (AHI = 6.3 ± 6.0). The control group included 35 age- and gender-matched individuals with no OSA risk as determined by a score of '0' on the Pediatric Sleep Questionnaire. Measured parameters included head and neck posture angles-cranio-cervical (SN-CVT°, SN-OPT°), cranio-vertical (SN-VER°, NL-VER°, ML-VER°), and cervico-vertical (OPT-VER°, CVT-VER°); hyoid bone position measurements-H-Mp, H-C3, H-Me distances; and airway dimensions-NAS, SPAS, MPAS, IPAS, PNS-U, and Sp1-Sp2. Intergroup comparisons were performed using independent samples t-test or Mann-Whitney U test, and Binary Logistic Regression analysis was performed.

Results: There were no statistically significant differences between the groups regarding hyoid bone position or airway dimensions. However, the OSA group exhibited significantly greater cranio-cervical and cranio-vertical angles: SN-CVT (OSA: 111.3°±10.4°; Control: 106.6°±8.0°; P = 0.018), SN-VER (OSA: 103.7°±3.5°; Control: 100.7°±5.4°; P = 0.007), and NL-VER (OSA: 95.4°±3.8°; Control: 92.8°±5.0°; P = 0.018). ANB and NL-VER angles had significant effects on the groups.

Conclusion: Pediatric patients with OSA, aged 9 to 16, demonstrated increased cranio-cervical and cranio-vertical angles, indicating a more extended head posture. This postural adaptation may serve as a clinical indicator of OSA in the pediatric orthodontic population.

Objective: Obstructive sleep apnea (OSA) is characterized by recurrent collapses of the upper airway during sleep. Although nasal obstruction has been identified as an independent risk factor for OSA and extensively studied, the relationship between nasal anatomical structures and OSA remains poorly understood. The objective of this study was to determine the relationship between the nasal cross-sectional area (CSA), as measured by magnetic resonance imaging in the supine position, and the presence of OSA, as well as to investigate its correlation with OSA severity.

Methods: In this cross-sectional study, a total of 111 participants were enrolled, comprising 88 patients with OSA and 23 healthy controls. All participants underwent polysomnography to determine their apnea-hypopnea index (AHI). Subsequently, MRI scans were performed in the supine position to measure CSA at distances of 1.5, 2, 2.5, 3, 4, 5, and 6 cm posterior to the most anterior point of the nasal cavity. Participants were stratified into groups based on AHI severity, and statistical analyses were conducted to determine the correlation between CSA measurements and the AHI.

Results: Significant intergroup differences were observed in the minimum CSA at the 2.5 and 4.0 cm levels. No difference was found in the sum of nasal CSA at any level. Furthermore, no group differences were found in either nasal cavity volume or surface area. A comparison between healthy individuals and OSA patients revealed that advanced age, a higher body mass index, male sex, and a reduced total minimum nasal cross-sectional area (TMCA) were independent and significant predictors of OSA.

Conclusion: TMCA was identified as a predisposing factor for OSA, but it was not found to be associated with the severity of the condition. Furthermore, long-term, severe OSA may contribute to an enlargement of the CSA.

Background: Quantification of the effect of orthodontic treatment on the gingival mircroaesthetics is lacking. The aim of this exploratory investigation was to investigate the effect of fixed orthodontic appliance therapy on gingival aesthetics associated with the anterior maxillary dentition.

Materials and methods: A bespoke gingival aesthetic criterion was used to assess 150 sets of pre- and post-treatment intra-oral photographs from a consecutively treated patient sample who had completed fixed appliance therapy. Five assessors rated the images assigning a score per criterion. Reliability of the method was assessed with concordance correlation coefficient (CCC) and Bland-Altman limits of agreement (LOA). Differences by timepoint, assessors, and treatment characteristics were assessed with statistical tests or generalized linear models at α = 5%.

Results: In the sample of 150 cases, the most common pre-treatment incisor classification was Class III (n = 57) followed by Class II Div 1 (n = 52). The majority of cases were treated on a nonextraction basis (n = 95) and involved orthodontic appliances only (n = 134). The CCC and LOA values for the aesthetic gingival criterion ranged from good-excellent. Average aesthetic summary scores differed from before pre-treatment [median = 33.9; interquartile range (IQR) = 24.5-45.2] and post-treatment (median = 75.8; IQR = 65.2-85.3) to a significant degree (mean difference = 38.5; standard deviation = 17.8; P < 0.001). No difference in aesthetic criterion points score was evident for treatment plan (nonextraction vs extraction) (P = 1.00) and treatment type (orthodontic only or orthognathic) (P = 0.52). Considerable variation in summary scores among assessors with different specialty/grades was seen (P < 0.001).

Limitations: Gingival aesthetic ratings were undertaken in isolation without the assessment of specific contributions made by soft and hard tissues, and changes in tooth position.

Conclusions: Orthodontic treatment with fixed appliances can have a positive effect on the gingival margin, gingival zenith, gingival embrasure, connector area, and overall rating of gingival symmetry of the anterior maxillary teeth. However, aesthetic ratings depend on the assessor.

Background: Functional appliances are widely used for Class II correction in growing patients, and their potential influence on upper-airway dimensions has been examined in several systematic reviews. However, methodological quality, overlap of primary studies, and credibility of evidence remain uncertain.

Objectives: To synthesize evidence from published systematic reviews and meta-analyses on functional appliances and airway dimensions in growing Class II patients, and to evaluate methodological quality, overlap, and credibility of evidence.

Search methods: Comprehensive electronic searches of PubMed, Embase, Cochrane Library, Scopus, Web of Science, and supplementary sources identified eligible systematic reviews up to August 2025.

Selection criteria: Systematic reviews or meta-analyses assessing airway changes after functional-appliance therapy in normal growing Class II patients with true external or growth-matched controls were included.

Data collection and analysis: Four systematic reviews encompassing 39 unique primary studies were retained. Methodological quality was assessed using the Joanna Briggs Institute (JBI) checklist and the Risk of Bias in Systematic Reviews (ROBIS) tool; study overlap was quantified by the Corrected Covered Area (CCA); credibility was evaluated using Ioannidis' classification; and evidence certainty was graded with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool.

Results: Meta-analyses revealed significant oropharyngeal enlargement: superior pharyngeal space + 1.73 mm (95% CI 1.13-2.32), middle + 1.52 mm (95% CI 1.09-1.96), and inferior + 1.25 mm (95% CI 0.66-1.84). Oropharyngeal airway volume increased by 2356 mm³ (95% CI 1276-3436) and nasopharyngeal volume by 382 mm³ (95% CI 141-623). Changes in posterior airway space (+0.52 mm, 95% CI -0.20 to 1.24) and upper-airway thickness were not significant. ROBIS classified four reviews as low-risk and two as high-risk. Study overlap was moderate (CCA = 6.8%). By Ioannidis' criteria, most outcomes were weak (Class IV) or non-significant. GRADE certainty was low to very low, mainly due to risk of bias, heterogeneity (I² up to 90%), and imprecision.

Conclusions: Functional appliances yield modest yet statistically significant enlargement of oropharyngeal airway dimensions in growing Class II patients, with the effect being more pronounced with removable appliances. Nevertheless, evidence credibility remains weak, and overall certainty is low. Results should be interpreted with caution, and future studies should employ prospective, volumetric, growth-controlled, and standardized protocols.

Registration: This umbrella review was registered with PROSPERO (CRD42023408859).

Aim: To assess the effect of smile shape on self-perceived smile attractiveness in young adults.

Methods: The study included 601 participants (393 females, 208 males). Three-dimensional smiling facial images were captured using the 3dMD stereophotogrammetry system (3dMD, Atlanta, USA). Participants rated their smile attractiveness using a visual analogue scale (0-100). Smile shape was described with 62 landmarks, which were aligned using Generalized Procrustes Superimposition to extract shape coordinates. Principal component analysis (PCA) was used to reduce dimensionality and derive shape PCs. The association between smile shape and self-perceived smile attractiveness was examined using multivariate regression models, performed separately for females and males. Allometric effects were assessed using standardized residuals of shape PCs. Statistical significance was set at P < .05.

Results: In males, no statistically significant association was found between smile shape and self-perceived smile attractiveness (P = .6; η2 = 0.065). In females, a significant association was observed (P = .001; η2 = 0.093), with more attractive smiles displaying greater width, height, and curvature. Allometric analysis revealed a strong effect of size on shape (η2 = 0.468; P < .001). After controlling for this effect, the association in females was no longer statistically significant (P = .08), although a moderate effect size persisted (η2 = 0.069), indicating that the effect remained but was statistically less robust.

Conclusion: Smile shape significantly affects self-perceived attractiveness, particularly in females, with effects related to proportionally larger smiles. This finding highlights known sex-based differences in aesthetic self-perceptions, as well as the preference for broader smiles.

Objective: To evaluate the impact of unilateral functional posterior crossbite, as well as its correction, on head posture in growing children in comparison to children without crossbite.

Methods: A prospective longitudinal controlled clinical trial was carried out including 40 children aged 8-11 years, assigned into a treatment group with unilateral functional posterior crossbite treated with maxillary expansion (n = 20) and an untreated control group without malocclusion (n = 20). Head posture was assessed pre-treatment (or pre-follow-up) (T0) and 2.5 years post-treatment (or post-follow-up) (T1) using an inertial measurement unit (IMU) measuring pitch (forward/backward head inclination), roll (left/right tilting), and yaw (left/right head rotation). Dominant-eye determination was performed using the Battista Della Porta aiming test to evaluate its potential influence on head posture.

Results: No significant differences in head posture were observed between the crossbite and control groups pre- (T0) or post-treatment (T1). Within the crossbite group, an increased pitch post-treatment was noted (P = .008), although not significant after Bonferroni correction. No significant changes were found in the roll or yaw axes neither between groups nor across time points. Eye dominance influenced yaw orientation, with right-eye-dominant participants showing higher yaw angles compared to left-eye-dominant participants (3.61+/-3.46° versus -1.47+/- 3.46°; P < .001).

Conclusion: The presence of a unilateral functional posterior crossbite does not appear to influence head posture, when compared with a control group without crossbite. Furthermore, the orthodontic correction of unilateral functional posterior crossbite does not seem to alter head posture. The results question a cause-effect relationship between crossbite and head posture. The study did identify however a significant influence of eye dominance on head posture.