Orthodontics & Craniofacial Research最新文献

Objectives: To compare skeletal, dentoalveolar, and dental changes following maxillary skeletal expansion using expanders of two different designs.

Materials and methods: This was a 2-arm parallel trial with 28 patients randomly assigned by an independent data monitor to two groups namely Maxillary Skeletal Expander with 4 miniscrews (MSE) and Favex expander with 6 miniscrews (FAVEX), using block randomisation in a 1:1 allocation ratio. Eligibility criteria included transverse skeletal deficiency, incomplete midpalatal suture ossification and presence of upper posterior teeth. Primary outcomes were the skeletal changes (Nasal Width-NW, Maxillary Width-MW, sutural expansion-SEM). Dentoalveolar and dental changes formed secondary outcomes. A total of 33 skeletal, dentoalveolar, and dental parameters were evaluated using cone beam computed tomography (CBCT). Analysis was done using paired t-test to evaluate the intragroup changes and independent t-test to compare difference between the groups.

Results: Successful skeletal expansion was obtained in both groups. MSE demonstrated significantly higher changes in NW, MW, SEM, Buccal Maxillary Width (BMW) and Palatal Maxillary Width (PMW) (p < 0.05). Buccal inclination of posteriors was significantly higher in the FAVEX group (p < 0.05).

Conclusion: Successful transverse expansion of the maxilla was obtained with both groups. Both primary (NW, MW, SEM) and secondary (BMW, PMW) outcomes were better in the MSE group.

Trial registration: The trial was registered at Clinical trials Registry (CTRI/2024/10/075097).

Introduction: This clinical trial aimed to compare the skeletal, dentoalveolar, and upper airway changes following maxillary expansion with bone-borne and hybrid mini-implant assisted rapid palatal expansion (MARPE) appliances in young adults with transverse maxillary deficiency.

Methods: Twenty-eight patients (mean age: 17.16 ± 1.73 years) were randomly allocated into two groups: bone-borne UxL MARPE (n = 13) and hybrid MSE MARPE (n = 15). Cone-beam computed tomography (CBCT) scans were obtained pre-expansion (T0) and post-retention (T1). Skeletal, dentoalveolar, and airway parameters were measured using 3D Slicer and ITK-SNAP software. Statistical analyses were performed using independent samples t-test and Mann-Whitney-U tests with signifance level p < 0.05.

Results: Both MARPE systems resulted in significant skeletal expansion. However, the UxL group demonstrated significantly greater increases in posterior buccal maxillary width (BMW4: p = 0.021; BMW5: p = 0.033) compared to the MSE group. No significant differences were found in other skeletal or dentoalveolar measurements. Airway changes were minimal in both groups, with no significant intergroup differences in nasopharyngeal, oropharyngeal, or hypopharyngeal dimensions (p > 0.05).

Conclusions: Both bone-borne and hybrid MARPE appliances are effective for correcting transverse maxillary deficiency in young adults. The bone-borne UxL appliance produced greater posterior skeletal expansion, while both systems showed similar effects on airway dimensions. These findings support evidence-based appliance selection in borderline surgical cases, favouring bone-borne devices for enhanced skeletal outcomes.

Objectives: To quantify secondary alveolar bone graft (SABG) resorption and the position of permanent upper canines in 3D in patients with bilateral cleft lip and/or palate (BCL/P).

Methods: Patients with BCL/P were prospectively included. CBCT scans were taken pre-operative (T0), at approximately 6 weeks (T1), 6 months (T2), 1-2 years (T3) and > 2 years post-operative (T4). Volumetric assessment of the bone grafts was performed across the time points to calculate the resorption rate. The position of the canines was assessed on the CBCT scans at all time points, determining angulation towards the midline and horizontal and vertical position, which were compared with the non-cleft side of a previously published unilateral cleft lip and/or palate (UCL/P) cohort.

Results: 16 patients with BCL/P were included in the study. At T2, 43.8% of the graft volume was resorbed. In patients whose canines had not erupted yet by T3, mean resorption was 51.5% at T3 and 58.9% at T4. For erupted canines at T3, resorption rates were 55.7% at T3 and 87.4% at T4. No significant difference in resorption rates was observed in comparison with those observed in patients with UCL/P, previously reported by Doucet et al. The canines tend to move more towards the midline; however, vertical movement towards the occlusal plane was similar.

Conclusions: Significant rates of SABG resorption were found in this BCL/P cohort. The vertical movement of the upper canine towards the occlusal plane was similar to that of the control group, confirming that SABG facilitates successful canine eruption.

Objective: To quantify external apical root resorption (EARR) on the incisors following non-extraction treatment of Class I malocclusion patients with moderate crowding, comparing clear aligners and fixed appliances using a novel 3D analysis of Cone-Beam Computed Tomography (CBCT) derived surface models.

Methods: In this randomized clinical trial, 32 adult patients, mean age 22.3 years, mean treatment duration 24.2 months, with Class I malocclusion and moderate crowding (mean Little's Index 4.76 mm) were allocated to either clear aligner (n = 15) or fixed appliance (n = 17) treatment. CBCT scans were obtained before and after treatment. EARR was measured using surface-based analysis of 3D models, and associations with patient and treatment-related factors were tested.

Results: The overall median EARR was -0.72 mm, with no significant difference between clear aligners (-0.71 mm) and fixed appliances (-0.72 mm). Upper lateral incisors exhibited significantly greater EARR than lower incisors (p = 0.002) and upper central incisors (p < 0.001). No significant predictor for EARR was found considering age, sex, crowding severity or treatment duration.

Conclusions: EARR occurred following non-extraction treatment of Class I malocclusion with both clear aligners and fixed appliances, with no significant difference between appliance types. Upper lateral incisors were most susceptible to EARR. The novel 3D analysis enabled comprehensive quantification of total EARR, setting a new methodological standard. Monitoring root health during treatment is important, particularly for upper lateral incisors.

Objective: To explore the expression of matrix metalloproteinase 9 and miRNA-337-3p in oral squamous cell carcinoma tissues and analyse their clinical significance.

Materials and methods: Postoperative specimens from 30 oral squamous cell carcinoma (OSCC) patients were collected from June 2022 to January 2023, and real-time fluorescence quantitative reverse transcription PCR was used to detect the expression levels of miR-337-3p in cancer tissues and adjacent normal tissues. The correlation between the expression levels of the two and the clinicopathological parameters of patients was analysed.

Results: Compared with adjacent normal tissues, the expression of miRNA-337-3p in OSCC tissues was significantly lower (p < 0.05), and its expression level was clearly related to the lymph node metastasis status of OSCC patients (p < 0.05). The positive rates of MMP-9 in OSCC tissue and adjacent normal tissue were 83.33% and 36.67% respectively. Compared with patients in the N0 stage, the expression level of miRNA-337-3p in OSCC tissues of patients in the N₁ + N₂ stage was significantly reduced (p < 0.05).

Conclusion: The expression of MMP-9 and miRNA-337-3p in OSCC tissues is related to cervical lymph node metastasis. miRNA-337-3p plays a tumour suppressor role in OSCC and may inhibit OSCC cell invasion and metastasis.

The temporomandibular joint (TMJ) may experience alterations during orthodontic treatments. Furthermore, gaps in the literature highlight a lack of robust evidence on the impact of clear aligner therapy (CAT) on the TMJ. This review aims to find the current evidence regarding the effects of CAT on the TMJ. Electronic searches were conducted in PubMed, Web of Science, Scopus, Embase, LILACS, The Cochrane Library and ProQuest Theses and Dissertations. The eligibility followed PECOS: Permanent-dentition patients (P); CAT (E); CAT group baseline parameters (C); TMJ structural parameters (O). Data extraction included sample size, age, control group characteristics, assessed outcomes, evaluation tools and it periods and main results. Risk of bias was assessed with the Joanna Briggs Institute checklist and the ROBINS-E tool. Certainty of evidence was determined using the GRADE approach. Of the 1490 references identified, only five met the eligibility criteria and were included. CAT was associated with dimensional alterations in the condyle volume and surface area, increased superior joint space and fossa depth and decreased condylar bone density. For condylar inclination or position, there are no significant changes. The certainty of evidence was low and very low, reasoned by studies design limitations and heterogeneity. Despite the lower number of studies and low evidence level, CAT seems to induce modest, predominantly increased changes in TMJ spaces and fossa depth, with insufficient clinical significance regarding if CAT effects on TMJ are positive or not. Future studies with standardised TMJ imaging are essential to establish more robust evidence. Trial Registration: PROSPERO CRD42024547484.

Objectives: To investigate the influence of non-syndromic hypodontia on radiographic dental development and to estimate dental age in children with bilateral mandibular agenesis using a machine learning approach.

Materials and methods: This retrospective cross-sectional study included 626 children aged 6-15 years (311 with dental agenesis, 315 matched controls). Dental age (DA) was assessed using the original Demirjian method. In cases with bilateral congenitally missing teeth in the mandible, DA was estimated using supervised machine learning models based on specific random forests, following a secondary-diagnosis approach. Dental developmental delay was calculated as the difference between dental and chronological age (DA-CA) and compared across groups defined by agenesis status, severity and pattern. Multiple linear regression was applied to evaluate the effects of hypodontia, sex, chronological age and their interactions on DA-CA.

Results: Eight random-forest models were trained, achieving good age-prediction accuracy (MAE = 0.08-0.28 years, R² > 0.95). A 0.77-year difference in dental development (95% CI 0.61-0.94) separated children with hypodontia from controls (p < 0.001). The regression model confirmed that agenesis status, sex and CA were significant predictors of DA-CA, with an interaction between sex and agenesis. Unilateral or bilateral agenesis of mandibular second premolars was associated with a dental developmental delay compared with controls (p_adj < 0.05).

Conclusion: Our results were consistent with broader evidence linking hypodontia to altered developmental timing. Machine learning imputation offers a robust approach for missing teeth and can be implemented for age estimation in larger cohorts for orthodontic or forensic purposes.

Introduction: Bone-anchored maxillary protraction (BAMP) has been increasingly used to correct midface deficiency and Class III malocclusion in patients with unilateral cleft lip and palate (UCLP). However, its three-dimensional (3D) effects on the mandible remain insufficiently explored.

Objectives: To quantitatively assess 3D mandibular displacement and remodelling, glenoid fossa adaptations, and joint space changes following BAMP treatment in patients with UCLP.

Methods: A longitudinal cohort of 26 patients with UCLP between ages 11-12 years was evaluated. CBCT scans were obtained before (T0) and after approximately 1.5 years of BAMP therapy (T1). 3D surface models were superimposed using three registration methods: anterior cranial base, mandibular symphysis and condylar head. Joint spaces (superior, anterior, posterior, medial) were measured on CBCT slices.

Results: The mean age of the cohort at T0 was 11.5 ± 0.5 years (range: 10.8-12.4 years), and at T1 was 13.2 ± 0.6 years (range: 11.3-14.3 years). The average treatment duration was 1.7 ± 0.4 years. Measurement reliability was moderate to good (ICC: 0.72-0.90). Significant posterior glenoid fossa remodelling was observed, characterised by anterior bone apposition and posterior resorption (both 0.95 ± 0.08 mm; p < 0.01). The mandible showed displacement in the vertical (2.11 ± 0.12 mm), posterior (1.06 ± 0.10 mm) and lateral (0.83 ± 0.09 mm) directions (p < 0.01). Remodelling along the posterior ramus showed greater change at the gonion (1.18 ± 0.07 mm) than at the condylar notch (0.52 ± 0.06 mm) (p < 0.01), resulting in a mild reduction in gonial angle. Morphological changes in the condylar head were minimal (< 0.30 mm), and alterations in joint spaces were negligible (< 0.20 mm).

Conclusions: BAMP therapy was associated with measurable mandibular and glenoid fossa adaptations, particularly in the posterior regions, while maintaining condylar and joint space stability. These findings suggest that BAMP treatment may help influence maxillomandibular growth and improve midfacial deficiency without adversely affecting normal mandibular development.

Clinical study registration number: 201700423/The Netherlands National Trial Register (TC 6559).

Objectives: This study aimed to assess how the anteroposterior position of the miniscrew-assisted rapid palatal expansion (MARPE) appliance influences maxillary skeletal expansion and to propose a reference point for optimal placement.

Material and methods: Thirty-two skeletally mature patients treated with MARPE were retrospectively assigned to an anterior group (anterior miniscrews ≥ 5 mm anterior to the centre of the maxilla (CM)) or a posterior group (≤ 2 mm from or posterior to CM). Pre- and post-expansion cone-beam computed tomography scans were used to measure skeletal, dental, and paramaxillary changes. Independent t-tests following data normality, linear regression with validated model assumptions, and Bayesian mediation analyses evaluated direct and indirect effects of appliance position and bicortical engagement.

Results: The anteroposterior appliance position significantly affected expansion outcomes. Posterior placement yielded greater skeletal expansion and a more parallel pattern (p = 0.008), especially in the posterior maxilla (p = 0.001). Anterior positioning produced reduced skeletal effects and a V-shaped expansion (p = 0.001). Molar tipping increased both directly with anterior positioning (p = 0.002) and indirectly through reduced bicortical engagements. Miniscrew movement, indicating activation loss, was likewise indirectly mediated by fewer bicortical engagements (95% highest density interval: [-0.140, -0.009]). The posterior group exhibited significantly greater paramaxillary expansion, especially in the posterior regions of the jugale and zygoma (p = 0.011).

Conclusion: Anteroposterior MARPE position significantly impacts skeletal expansion results. Positioning near or posterior to the centre of the maxilla point enhances parallel skeletal expansion and minimizes undesirable dental effects. This reference point can serve as a practical reference to optimize MARPE placement for mature patients.

Objective: To explore the effect of personalised titanium plate Bone-anchored maxillary protraction (BAMP) on the maxillofacial structure of adolescents with skeletal Class III malocclusion.

Methods: A total of 20 patients with skeletal Class III malocclusion were selected as the treatment group 1 (TG1) with treatment using individualised BAMP. Twenty patients were selected as treatment group 2 (TG2) with treatment using facemask traction. Twenty-six patients were selected as the control group (CG) for non-interventional observation. The baseline and interval length of the three groups were matched, and a one-way ANOVA was used to compare the differences in results between the treatment group 1 and the other two groups.

Results: Compared with TG2, there was a statistically significant difference in the change of the MP-FH (-1.07° ± 0.87° vs. 1.43° ± 1.95°), S-Ar-Go' (-0.64° ± 1.79° vs. 1.88° ± 4.07°), Ar-Go'-Me (-2.84° ± 1.57° vs. -1.22° ± 1.45°, p < 0.05). Compared with CG, there was a statistically significant difference in the Ptm-A (1.95 ± 1.58 mm vs. -0.39 ± 1.45 mm), Na-S-Ar (2.06° ± 1.77° vs. -0.35° ± 3.81°), Ar-Go'-Me (-2.84° ± 1.57° vs. 1.80° ± 4.76°, p < 0.05).

Conclusion: Customised titanium plates combined with BAMP can be used to treat patients with skeletal Class III malocclusion during or after the peak phase of growth and development. By changing the morphology of the mandible and its positional relationship relative to the maxilla, the sagittal relationship and lateral appearance of patients with skeletal Class III malocclusion can be effectively improved, as well as the lip inclination of the upper and lower incisors. Compared with facemask protraction, this approach yields distinct vertical changes and mandibular orthopaedic effects, necessitating the selection of appropriate treatment protocols based on the patient's vertical growth pattern in clinical practice.