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The transverse dimensions of internasal and nasopremaxillary sutures in rats were assessed at different ages and following different dietary functional demands.Eighty-four male Wistar rats were divided into two groups fed either a hard or a soft diet from 4 weeks of age, and sacrificed at 4 weeks (baseline: n = 12),16 weeks (n = 24), 26 weeks (n = 24), or 38 weeks (n = 24) of age. High-resolution micro-computed tomograms of the internasal and left nasopremaxillary sutures were obtained with 10 µm voxel size and 5 × 5 mm field of view. The endocranial and ectocranial suture widths, the mean suture width, and the suture height were measured. Linear regression analysis was used to estimate the effects of age and type of diet on suture dimensions. Internasal and nasopremaxillary suture dimensions were influenced by age, with a generally lower width and a larger height in the older animal. Regarding diet consistency, internasal suture widths were on average larger in the hard-diet group (e.g., mean suture width 43 µm in the hard- versus 30 µm in the soft-diet group at 26 weeks). In conclusion, the internasal and nasopremaxillary sutures tend to become narrower with age, while being influenced by masticatory functional demands., (© 2024 The Author(s). European Journal of Oral Sciences published by John Wiley & Sons Ltd on behalf of Scandinavian Division of the International Association for Dental Research.)

Objectives. To evaluate the accuracy and reproducibility of measurements obtained using the Bellus3D Face Application on a mobile smartphone by comparing them to direct measurements on pre-marked and blank face scans. Materials and Methods. Twenty-five healthy young adults (six males and nineteen females; age range 20-30 years) were included in this prospective cross-sectional study, with the only exclusion criterion being the presence of significant facial hair interfering with the placement and visualization of landmarks. Image acquisitions were performed using an iPhone XR with the Bellus3D FaceApp face scanning application, an iOS application for smartphones. Ten single midfacial and five paired bilateral landmarks were defined and marked. Two face scans were performed on each patient, both on blank and marked faces, and distances were measured directly with calipers and digitally. Results. The random error values were 1.0 mm and 0.4 mm for the manual point placement and measurements and virtual point placement on blank faces, respectively. The two methods used (the direct method and acquisition on faces with landmarks) demonstrate relatively similar reliability (ICC > 0.8); however, a paired t -test showed that the differences between several measurements were statistically significant ( p < 0.05). Regardless of the method used, there was a systematic error for various values that included the nose and mouth ( p < 0.05). The measurements demonstrating the most significant differences between the methods were those that included the tip of the nose, with the mean differences being -4.4-3.3 mm. The measurements of the distances that estimate face "depth" showed the greatest consistency irrespective of the tested method ( p > 0.05 and ICC > 0.8). Conclusions. The use of the Bellus3D FaceApp is precise and reproducible for certain areas of the face, but digital reconstruction errors prohibit, for the time being, the use of this technology in everyday clinical practice. The noted discrepancies were consistent and more prevalent for specific areas such as the tip of the nose. Further investigations are required to determine other sources of error and for other smartphone-based applications released for 3D face image acquisitions.

Objectives: To evaluate three-dimensional movements of maxillary teeth during headgear treatment in Class II growing children, using digital analytical tools, and to determine the effects of compliance on these movements., Materials and Methods: A 9-month parallel-group randomized controlled trial was carried out on 40 children with Class II malocclusion, aged 8-12 years, half assigned to receive a cervical headgear and half to a no-treatment group, using block randomization. Subjects in the treatment group were instructed to wear the headgear for 12 hours daily and monitored using an electronic module. After 9 months, the following dental outcomes were measured: first maxillary molar distalisation, rotation, tip and torque, arch depth, and interpremolar and intermolar distances. Caregivers and participants were not blinded to group assignments, but those assessing outcomes were. Linear regression models were used to detect differences between groups and correlation coefficients to find correlations between compliance and dental outcomes., Results: All 40 included patients were analysed. A significant difference in molar distalisation was observed between the treatment (1.2 mm) and control groups (-0.2 mm). Arch depth change was also increased to a larger extent in the treatment groups (1.3 mm vs 0.1 mm), as was the interpremolar distance (1.9 mm vs 0.4 mm). In contrast, no significant differences in molar rotation or torque change were observed. With regard to compliance, average compliance was 55%. A significant correlation was found between molar distalisation and compliance in the treatment group., Conclusions: Headgear therapy has significant effects on molar distalisation, arch depth, and arch width. Compliance has a significant positive effect on molar distalisation., (© 2024 The Authors. Orthodontics & Craniofacial Research published by John Wiley & Sons Ltd.)

This study aimed to investigate the influence of various patient-specific and bracket location-specific factors on bracket survival rates during comprehensive fixed appliance orthodontic treatment. A total of 197 patients (116 females, 81 males; mean age 16.3 years) having completed orthodontic treatment were included in this retrospective cohort study. Patients were treated using stainless steel non-self-ligating brackets, and the treatment duration was 23.7 months on average. The primary outcome was bracket bond failure. Potential predictors for bracket bond failure recorded included age, sex, oral hygiene, treatment duration, and several pre-treatment cephalometric characteristics such as overjet, overbite, and sagittal and vertical skeletal relationships. Factors associated with bracket failure were analysed with Cox regression, and proportional hazard assumptions were assessed using Kaplan-Meier tests. The overall failure rate was 4.4%. Bracket bond failure rates varied among tooth types and seemed to occur more on posterior teeth and on the right side of the arch. Bracket failure was more common in male patients and those with poor oral hygiene. Concerning dentofacial characteristics, bracket failure of anterior teeth was more common in those with an increased overjet and overbite.

Background: The anatomic characteristics of the masticatory muscles differ across craniofacial skeletal patterns., Objective: To identify differences in the anatomic characteristics of masticatory muscles across different sagittal and vertical craniofacial skeletal patterns., Eligibility Criteria: Studies measuring the thickness, width, cross-sectional area (CSA), volume and orientation of masticatory muscles in healthy patients of different sagittal (Class I, Class II, and Class III) and/or vertical (normodivergent, hypodivergent, and hyperdivergent) patterns., Information Sources: Unrestricted literature searches in 8 electronic databases/registers until December 2023., Risk of Bias and Synthesis of Results: Study selection, data extraction, and risk of bias assessment with a customised tool were performed independently in duplicate. Random-effects meta-analysis and assessment of the certainty of clinical recommendations with the GRADE approach were conducted., Results: 34 studies (37 publications) were selected with a total of 2047 participants and data from 16 studies were pulled in the meta-analysis. Masseter muscle thickness in relaxation was significantly greater by 1.14 mm (95% CI 0.74-1.53 mm) in hypodivergent compared to normodivergent patients while it was significantly decreased in hyperdivergent patients by - 1.14 mm (95% CI - 1.56 to - 0.73 mm) and - 2.28 mm (95% CI - 2.71 to - 1.85 mm) compared to normodivergent and hypodivergent patients respectively. Similar significant differences were seen between these groups in masseter muscle thickness during contraction as well as masseter muscle CSA and volume. Meta-analyses could not be performed for sagittal categorizations due to insufficient number of studies., Conclusions: Considerable differences in masseter muscle thickness, CSA and volume were found across vertical skeletal configurations being significantly reduced in hyperdivergent patients; however, results should be interpreted with caution due to the high risk of bias of the included studies. These variations in the anatomic characteristics of masticatory muscles among different craniofacial patterns could be part of the orthodontic diagnosis and treatment planning process., Registration: PROSPERO CRD42022371187 ., (© 2024. The Author(s).)

This study aimed to assess the impact of occlusal loading on secondary tooth eruption and to determine the extent to which altering the occlusal loading influences the magnitude of secondary eruption through an experimental rat model. The present sample consisted of 48 male Wistar rats. At the onset of the experiment, 24 rats were 4 weeks old (young rats) and 24 rats were 26 weeks old (adult). Within each age group, the rats were further divided into two equal subgroups (12 rats each), receiving either a soft- or hard-food diet for the 3-month duration of the experiment. The primary outcome was the tooth position changes relative to stable references in the coronal plane by evaluating the distance between the mandibular first molars and the inferior alveolar canal. Microcomputed tomography scans were taken from all rats at three standardized intervals over the 3-month study period. Descriptive statistics were calculated by age and diet over time, and the evolution of the outcomes were plotted by age and diet over time. Longitudinal data analysis via generalized estimating equations was performed to examine the effect of age, diet and time on the primary outcomes. Secondary tooth eruption was observed in all age groups (young and adult) regardless of diet consistency (soft or hard food). In young rats, the secondary eruption was greater in the animals fed a soft diet than those fed a hard diet. In adult rats, minimal difference in secondary tooth eruption were found between different diet consistencies. Occlusal loading influences secondary tooth eruption in teeth with an established occlusal contact. The quantity of eruption in growing rats is higher when occlusal loading is less, providing a certain amount of secondary tooth eruption occurs. This difference, however, is not evident in adult rats, at least during the given 3-month time frame., (© 2024 The Author(s). Journal of Morphology published by Wiley Periodicals LLC.)

Aims: The present aim was to evaluate vertical cephalometric characteristics in populations with Turner syndrome (TS) using meta-analysis methodology., Methods: Six electronic databases were queried, up to August 2023, to identify studies comparing the vertical cephalometric characteristics in populations with TS, compared to female control groups. Data were extracted from eligible studies and random-effects meta-analysis was employed. Subgroup meta-analyses for age and karyotype were also attempted. Risk of bias was assessed using a modified version of the AXIS tool., Results: From the initial 195 studies identified, 17 were included in the quantitative synthesis, resulting in a sample of 417 patients with TS, originating from 10 different countries. Risk of bias was overall questionable. Mandibular ramus height was found to be smaller in females with TS, along with a reduction in posterior facial height, a larger anterior-posterior facial height ratio, and an increase in the mandibular plane angle. Subgroup meta-analyses showed that females with the monosomy X karyotype had vertical cephalometric characteristics which deviated more from the norm than those with other karyotypes., Conclusion: The vertical lateral cephalometric characteristics of females with TS differ significantly from those of non-syndromic females, with the largest and most consistent deviation being seen in the monosomy X karyotype. Females with TS show less craniofacial posterior vertical development, with an evident reduction in mandibular ramus height leading to the cephalometric characteristics observed., (© 2024 The Authors. Special Care in Dentistry published by Special Care Dentistry Association and Wiley Periodicals LLC.)

In patients with advanced periodontal disease, pathological tooth migration may occur, which may require subsequent orthodontic treatment for both aesthetic and functional purposes. When planning orthodontic treatment mechanics, intrusive or extrusive forces are frequently indicated. Understanding tissue reactions during these movements is essential for clinicians when devising a comprehensive orthodontic-periodontal treatment plan. This knowledge enables clinicians to be fully aware of and account for the potential effects on the surrounding tissues. The majority of our understanding regarding the behavior of periodontal tissues in both healthy and compromised periodontal conditions is derived from animal studies. These studies offer the advantage of conducting histological and other assessments that would not be feasible in human research. Human studies are nevertheless invaluable in being able to understand the clinically relevant response elicited by the periodontal tissues following orthodontic tooth movement. Animal and human data show that in dentitions with reduced periodontal support, orthodontic intrusion of the teeth does not induce periodontal damage, provided the periodontal tissues do not have inflammation and plaque control with excellent oral hygiene is maintained. On the contrary, when inflammation is not fully controlled, orthodontic intrusion may accelerate the progression of periodontal destruction, with bacterial plaque remnants being displaced subgingivally, leading to further loss of attachment. Orthodontic extrusion, on the other hand, does not seem to cause further periodontal breakdown in dentitions with reduced periodontal support, even in cases with deficient plaque control. This is attributed to the nature of the tooth movement, which directs any plaque remnants coronally (supragingivally), reducing the risk of adverse effects on the periodontal tissues. This specific type of tooth movement can be leveraged to benefit periodontal conditions by facilitating the regeneration of lost hard and soft periodontal tissues in a coronal direction. As a result, orthodontic extrusion can be employed in implant site development, offering an advantageous alternative to more invasive surgical procedures like bone grafting. Regardless of the tooth movement prescribed, when periodontal involvement is present, it is essential to prioritize periodontal therapy before commencing orthodontic treatment. Adequate plaque control is also imperative for successful outcomes. Additionally, utilizing light orthodontic forces is advisable to achieve efficient tooth movement while minimizing the risk of adverse effects, notably root resorption. By adhering to these principles, a more favorable and effective combined orthodontic-periodontal approach can be ensured. The present article describes indications, mechanisms, side effects, and histological and clinical evidence supporting orthodontic extrusion and intrusion in intact and reduced periodontal conditions., (© 2024 The Author(s). Periodontology 2000 published by John Wiley & Sons Ltd.)

Background: Skeletal craniofacial morphology can be influenced by changes in masticatory muscle function, which may also change the functional profile of the muscles., Objectives: To investigate the effects of age and functional demands on the expression of Myosin Heavy-Chain (MyHC) isoforms in representative jaw-closing and jaw-opening muscles, namely the masseter and digastric muscles respectively., Methods: Eighty-four male Wistar rats were divided into four age groups, namely an immature (n = 12; 4-week-old), early adult (n = 24; 16-week-old), adult (n = 24; 26-week-old) and mature adult (n = 24; 38-week-old) group. The three adult groups were divided into two subgroups each based on diet consistency; a control group fed a standard (hard) diet, and an experimental group fed a soft diet. Rats were sacrificed, and masseter and digastric muscles dissected. Real-time quantitative polymerase chain reaction was used to compare the mRNA transcripts of the MyHC isoforms-Myh7 (MyHC-I), Myh2 (MyHC-IIa), Myh4 (MyHC-IIb) and Myh1 (MyHC-IIx)-of deep masseter and digastric muscles., Results: In the masseter muscle, hypofunction increases Myh1 (26, 38 weeks; p < .0001) but decreases Myh4 (26 weeks; p = .046) and Myh2 (26 weeks; p < .0001) expression in adult rats. In the digastric muscle, hypofunction increases Myh1 expression in the mature adult rats (38 weeks; p < .0001), while Myh2 expression decreases in adult rats (26 weeks; p = .021) as does Myh4 (26 weeks; p = .001). Myh7 expression is increased in the digastric muscle of mature adult rats subjected to hypofunction (38 weeks; p = <.0001), while it is very weakly expressed in the masseter., Conclusion: In jaw-opening and jaw-closing muscles, differences in myosin expression between hard- and soft-diet-fed rats become evident in adulthood, suggesting that long-term alteration of jaw function is associated with changes in the expression of MyHC isoforms and potential fibre remodelling. This may give insight into the role of function on masticatory muscles and the resultant craniofacial morphology., (© 2024 The Authors. Journal of Oral Rehabilitation published by John Wiley & Sons Ltd.)

Objective: To assess the characteristics of popular videos on YouTube about the feeding of infants with cleft lip and palate (CLP) and analyze the adequacy of information provided by them., Design: A cross-sectional design was used., Methods: YouTube was systematically searched for consecutive relevant videos about the feeding of infants with CLP, using predefined keyword combinations, without any limitations on language or duration. Scrutiny of the top 50 videos for each keyword combination was performed and a self-designed data-extraction sheet was used. A content adequacy index was developed by an expert group, and used to assess content adequacy, classifying it into categories from excellent to poor., Results: From an initial retrieval of 200 videos, 42 were included in the final assessment. The videos originated from nine different countries, with more than half coming from the USA and in English. Five of the videos came from the channel of the American Cleft Palate-Craniofacial Association. Content adequacy analysis showed that no video could be classified as excellent, while 33.3% were classified as optimal, 21.4% as suboptimal and 45.2% as poor., Conclusions: The content adequacy of the majority of videos on YouTube, relating to the feeding of infants with CLP was inadequate, with only one third of them achieving optimal content adequacy. Efforts must be made to develop informative and standardized videos for social media and video-sharing platforms, perhaps through professional associations to ensure that families with an infant with CLP receive appropriate information., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Craniofacial skeletal discrepancies have been associated with upper airway dimensions., Objective: To identify differences in upper airway volume across different sagittal and vertical skeletal patterns., Search Methods: Unrestricted literature searches in eight databases/registers for human studies until May 2023., Selection Criteria: Cross-sectional studies measuring upper airway volumes using three-dimensional imaging in healthy patients of different sagittal (Class I, Class II, and Class III) or vertical (normodivergent, hypodivergent, and hyperdivergent) craniofacial morphology., Data Collection and Analysis: Duplicate independent study selection, data extraction, and risk of bias assessment. Random-effects frequentist network meta-analysis was performed followed by subgroup-analyses and assessment of the quality of clinical recommendations (confidence in effect estimates) with the CINeMA (Confidence in Network Meta-Analysis) approach., Results: Seventy publications pertaining to 66 unique studies were included with 56 studies (5734 patients) contributing to meta-analyses. Statistically significant differences were found for total  pharyngeal airway volume, with Class II having decreased airway volume (-2256.06 mm3; 95% Confidence Interval [CI] -3201.61 to -1310.51 mm3) and Class III increased airway volume (1098.93 mm3; 95% CI 25.41 to 2172.45 mm3) compared to Class I. Significant airway volume reductions for Class II were localized mostly at the oropharynx, followed by the palatopharynx, and the glossopharynx. Significant airway volume increases for Class III were localized mostly at the oropharynx, followed by the intraoral cavity, and hypopharynx. Statistically significant differences according to vertical skeletal configuration were seen only for the oropharynx, where hyperdivergent patients had reduced volumes compared to normodivergent patients (-1716.77 mm3; 95% CI -3296.42 to -137.12 mm3). Airway differences for Class II and Class III configurations (compared to Class I) were more pronounced in adults than in children and the confidence for all estimates was very low according to CINeMA., Conclusions: Considerable differences in upper airway volume were found between sagittal and vertical skeletal configurations. However, results should be interpreted with caution due to the high risk of bias, owing to the retrospective study design, inconsistencies in anatomic compartment boundaries used, samples of mixed children-adult patients, and incomplete reporting., Clinical Trial Registration: PROSPERO (CRD42022366928)., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Orthodontic Society.)

When treating posterior crossbite, the primary goal is to achieve long-term crossbite correction. The majority of studies however focus on relapse of the increase in the transverse dimension, but not relapse of the crossbite itself, which is an essential outcome. The aim of the present study was to determine long-term stability (2 years minimum post-treatment) of posterior crossbite correction, treated in mixed or early permanent dentitions of growing children. Following registration in PROSPERO (CRD42022348858), an electronic literature search including PubMed, Embase, Web of Science, the Cochrane Library, and a manual search were conducted up to January 2023, to identify longitudinal studies looking into the long-term stability of crossbite correction in growing children. Data extraction and risk of bias assessment were carried out, and subsequently, a random-effects meta-analyses models were used to calculate estimates for relapse of the crossbite and relapse at the transverse level. Twenty-two studies were included, of varying designs and quality, representing 1076 treated patients, with different expansion appliances and protocols. Meta-analysis results showed that 19.5% (95% CI: 15%; 25%) of patients present with relapse of posterior crossbite at long-term follow-up. At the transverse level, 19.3% of the total expansion (including overexpansion) relapsed (95% CI: 13%; 27%) regardless of whether there a was relapse of the crossbite itself. Data from existing studies, with a moderate level of evidence, indicate that the long-term stability of posterior crossbite correction in growing children is unfavourable in roughly 1 in 5 growing children, with crossbite relapse long-term. On average, 19% of the maxillary expansion performed (including overexpansion) relapses long-term, which may occur in cases with or without relapse of the crossbite., (© 2023 The Authors. Orthodontics & Craniofacial Research published by John Wiley & Sons Ltd.)

The aim of the present systematic review was to assess the trends in knowledge, attitude, awareness, and practice among orthodontists regarding the management of patients with cleft lip and/or palate., An a priori protocol was developed as per the best practices of evidence-based medicine and registered in Prospero (CRD42022306107). The literature search was conducted electronically, using MeSH-terms, keywords, and Boolean-operators "AND" and "OR" in different combinations in multiple databases and screening of titles and abstracts followed by full-text evaluation was performed. The risk of bias (ROB) was assessed using Joanna Briggs Institute critical appraisal checklist., Five studies were included in the qualitative synthesis and three of them showed a high ROB. When participants were questioned about which other specialists worked in the cleft team in addition to the orthodontists, 84% of them in one study reported it to be general dentists. Furthermore, the absence of an interdisciplinary team was reported in two studies from Africa. When asked about the percentage of their practice devoted to the care of patients with cleft lip and palate (CLP) one study reported that 52% of orthodontists had treated <10 such patients in their entire career., The present systematic review highlights the lack of knowledge and experience among orthodontists and orthodontic residents regarding the management of patients with CLP. Efforts must be made to design validated questionnaires and conduct methodologically sound studies in different geographical locations to develop adequate modules for improving the knowledge of orthodontists in this domain., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Management of cleft lip and palate is interdisciplinary. An evidence-mapping approach was envisaged to highlight the existing gaps in this field, using only the highest level of evidence., Objectives: To conduct evidence mapping and quality analysis of systematic reviews and meta-analyses related to any aspect of cleft lip and palate., Search Methods: The cleft lip and palate field was divided into 9 domains and 50 subdomains and a method of categorization of systematic reviews was established. A comprehensive search strategy was carried out in seven databases along with the search of gray literature and references of included articles., Selection Criteria: Systematic reviews related to any aspect of cleft lip and palate, conducted by a minimum of two reviewers, with a comprehensive search strategy and adequate quality analysis were included., Data Collection and Analysis: A self-designed, pre-piloted data-extraction sheet was used to collect information that was analyzed through an expert group discussion. Quality analysis was performed using ROBIS-I, AMSTAR 2, and the PRISMA checklist., Results: A total of 144 systematic reviews published between 2008 and 2022 were included. The largest number of these could be categorized in the therapeutic domain (n = 58). A total of 27% of the studies were categorized as inconclusive, 40% as partially conclusive, and 33% as conclusive. As per ROBIS-I, 77% of reviews had high risk of bias while 58% were graded as critically low in quality as per AMSTAR 2. The majority of systematic reviews showed low reporting errors., Conclusions: The majority of systematic reviews related to cleft lip and palate relate to therapeutic and prognostic domains and show high risk of bias and critically low quality regardless of the source journal. The results of this paper might serve as a starting point encouraging authors to carry out high-quality research where evidence is lacking., Registration: A multidisciplinary expert-group formulated an a priori protocol, registered in Open Science Framework (DOI 10.17605/OSF.IO/NQDV2).

Objectives: The aim of the present meta-analysis was to provide a complete synthesis of all studies involving lateral cephalometric measurements in populations with Down Syndrome (DS)., Methods: A literature search was carried out using six electronic databases to identify studies comparing cephalometric characteristics between populations with DS and control (healthy) populations. Studies were selected according to the research objectives, and predefined inclusion and exclusion criteria. Only the cephalometric measurements included in three or more studies selected were analyzed. The random-effects meta-analysis model was used for data analysis, and all analyses were carried out using RevMan5 software., Results: From an initial 871 articles identified through the literature search, ten cross-sectional studies were finally selected based on the inclusion and exclusion criteria. Ten cephalometric measurements underwent meta-analysis, five linear and five angular measurements. Concerning the five linear measurements, namely S-N, ANS-PNS, Go-Gn, Ar-Go, and N-ANS, all were significantly smaller in the DS group with the exception of Go-Gn. Of the five angular measurements, only three were statistically different between the DS and control groups. SNB and ANB angles were smaller in individuals with DS, whereas the basilar angle was larger. Subgroup analysis was also carried out based on age, and it was found that the gonial angle was significantly smaller before puberty, in individuals with DS. No differences between groups were found for the SNA angle., Conclusion: There are significant cephalometric differences between individuals with and without DS. Individuals with DS have a shorter anterior cranial base, maxillary length, upper anterior facial height and mandibular height. The ANB and SNB angles were also smaller in those with DS, but the SNA angle showed no differences. These findings may indicate that the Class III malocclusion commonly found in individuals with DS does not seem to be due to mandibular prognathism., Clinical Relevance: Lateral cephalometric measurements in individuals with DS show significant differences from individuals without DS. Practitioners need to be aware of this and monitor growth from an early age in these children., Competing Interests: Declaration of Competing Interests The authors disclose no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Aim: To evaluate the effects of two air-polishing powders, during orthodontic treatment, on the surface roughness of sound and demineralised enamel., Materials and Methods: Forty-two caries-free human molars were collected, and the enamel surfaces were flattened and polished. Teeth were assigned to two groups ( n = 21 each), a sound- and a demineralised-enamel group (subjected to pH-cycling over 2 weeks to create artificially induced white spot-like lesions). Within each group, teeth were further assigned to three groups ( n = 7 each), air polished with either sodium bicarbonate, erythritol, or a negative control (water). Each sample was treated for 5 and 150 s. The average surface roughness (Ra) for each sample was measured using white-light-sensor profilometry., Results: On sound enamel, the Ra was roughly 0.17 ± 0.07 μm. After 150 s of air polishing, the Ra increased with erythritol (by 0.28 μm), and even more so with bicarbonate treatment (by 0.68 μm) ( p < 0.01). On demineralised enamel, the Ra was roughly 0.79 ± 0.56 μm. The Ra increased after 5 s of air-polishing treatment similarly with erythritol and bicarbonate powders (by 1.03 μm and 1.04 μm, respectively) ( p = 0.025), and even more after 150 s (by 2.48 μm and 2.49 μm, respectively) ( p < 0.001)., Conclusions: On white spot lesions, one should be aware that enamel surface roughness will increase with both erythritol and bicarbonate air-polishing powders, especially with longer exposure times.

Objective: To evaluate the dimensional changes that occur in the internasal and nasopremaxillary sutures, and related transverse craniofacial dimensions, of rats from 4 to 38-weeks of age. Methods: Four groups of twelve male Wistar rats were sacrificed at different ages [4-weeks (immature), 16-weeks (adolescent), 26-weeks (young adult), 38-weeks (adult)]. The rats were scanned with a high-resolution micro-computed tomography imaging device with 90 µm voxel size and 45 mm × 45 mm field of view (FOV) to obtain images of the viscreocranium, and with 10 µm voxel size and 5 mm × 5 mm FOV to obtain images of the internasal and left nasopremaxillary sutures. The nasal bone width, transverse width between the nasopremaxillary sutures and interzygomatic width were measured as craniofacial measurements. The endocranial, ectocranial and mean suture widths (cross-sectional area between endocranial and ectocranial borders/suture height), and suture height were measured at 5 frontal planes with 1.2 mm intervals. Outcomes were compared at different ages, and correlation coefficients were used to assess the relationship between craniofacial and suture changes. Results: All transverse craniofacial dimensions increased significantly from 4-16 weeks of age ( p < 0.001). After 16-weeks of age, the only significant increase was observed in interzygomatic width ( p = 0.02), between 26 and 38 weeks. In both the internasal and nasopremaxillary sutures, the endocranial suture mean widths decreased from 4-16 weeks ( p < 0.001 and p = 0.002, respectively), but did not show any significant change after 16-weeks of age. The ectocranial internasal suture width decreased from 4-16 weeks ( p < 0.001), increased until 26-weeks ( p = 0.035), and subsequently decreased ( p < 0.001). The nasopremaxillary suture widths decreased from 4-38 weeks to varying degrees in different frontal planes. Except for the internasal ectocranial suture width, all suture measurements were found highly and negatively correlated with the transverse craniofacial dimensions. The height of the sutures increased with time, with the most significant changes occurring between 4 and 16 weeks of age ( p < 0.001). Conclusion: Although the internasal and nasopremaxillary endocranial suture widths nearly reach their final widths during adolescence, the changes in the ectocranial and mean suture widths continue into early adulthood. These results may serve as a reference for future studies aiming to evaluate the effects of functional demands on suture development and dimensional changes of the viscerocranium., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Gorucu-Coskuner, Al-Yassary, Billiaert, Kiliaridis and Antonarakis.)

Different demands on the muscles of mastication may influence their functional profile (size and distribution of muscle fibre types), which may change during growth and maturation, potentially influencing craniofacial growth. The aim of this study was to evaluate mRNA expression and cross-sectional area of masticatory muscle fibres compared with limb muscles in young and adult rats. Twenty-four rats were sacrificed at two different ages, namely 12 at 4 weeks (young) and 12 at 26 weeks (adult). The masseter, digastric, gastrocnemius and soleus muscles were dissected. Gene expression of myosin heavy-chain isoforms Myh7 (MyHC-I), Myh2 (MyHC-IIa), Myh4 (MyHC-IIb) and Myh1 (MyHC-IIx) in the muscles was measured using qRT-PCR RNA analysis, and immunofluorescence staining was performed to measure the cross-sectional area of different muscle fibre types. Different muscle types and ages were compared. Significant differences were found in the functional profile between masticatory and limb muscles. For the masticatory muscles, there was an increase in Myh4 expression with age, and this change was more intense for the masseter muscles, which also presented an increase in Myh1 expression, similarly to limb muscles. The fibre cross-sectional area of the masticatory muscles was generally smaller in young rats; however, this difference was less pronounced than in limb muscles.

Background: Individuals with amelogenesis imperfecta (AI) often present with malocclusions, especially a dental or skeletal anterior open bite (AOB)., Objectives: To evaluate the craniofacial characteristics in individuals with AI., Material and Methods: A systematic literature search was conducted with the PubMed, Web of Science, Embase and Google Scholar databases to identify studies relating to the cephalometric characteristics of individuals with AI, without any language or publication date restrictions. The grey literature was searched using Google Scholar, Opengrey and Worldcat. Only studies with a suitable control group for comparison were included. Data extraction and a risk of bias assessment were carried out. A meta-analysis was performed using the random effects model for cephalometric variables that were evaluated in at least three studies., Results: The initial literature search yielded 1857 articles. Following the removal of duplicates and a screening of the records, seven articles were included in the qualitative synthesis, representing a total of 242 individuals with AI. Four studies were included in the quantitative synthesis. The meta-analysis results showed that individuals with AI present a smaller SNB angle and larger ANB angle than those of control groups in the sagittal plane. In the vertical plane, those with AI present a smaller overbite and larger intermaxillary angle than those without AI. No statistically significant differences were found for the SNA angle when comparing the two groups., Conclusions: Individuals with AI seem to present with more vertical craniofacial growth, leading to an increased intermaxillary angle and decreased overbite. This possibly leads to a more retrognathic mandible with a larger ANB angle due to an anticipated posterior mandibular rotation.

Introduction: This study aimed to evaluate potential vertical changes in the position of the maxillary labial frenum (MLF) insertion in growing children and to compare these changes to the vertical growth of the dentoalveolar process and lower facial third., Methods: This retrospective longitudinal study investigated records of 33 healthy children. Dental casts, lateral cephalograms, and photographs were evaluated at pretreatment (T0), posttreatment (T1), and 3-5 years into retention (T2). To evaluate the vertical changes of MLF insertion in relation to the vertical growth of the dentoalveolar process, the palatal plane (PP) was used as a reference. These changes were also compared between different MLF typologies (ascribed as thin or fibrous)., Results: The distance from MLF to PP only slightly increased from T0 to T2 by 0.6 ± 0.5 mm (P <0.001), whereas the distance between the incisal edge and PP increased significantly from T0 to T2 by 2.6 ± 0.8 mm (P <0.001). A positive correlation was found (r = 0.94; P <0.001) between the changes from the incisal edge to the PP and the MLF to the incisal edge between T0 and T2. No correlation was found between the change from the incisal edge to the PP and MLF to PP between T0 and T2. Thin MLF types showed a larger increase in distance from their insertion to the incisal edge (2.6 ± 0.8 mm) than thick MLF types (1.8 ± 0.7; P <0.03)., Conclusions: The MLF remains stable compared with the PP, whereas the maxillary incisal edge moves away from the PP, indicating increased vertical growth of the alveolar process. Dentists should be aware of those changes before performing interventions such as unnecessary frenectomies., (Copyright © 2022 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Aim: To determine (a) the prevalence of spontaneous correction of posterior crossbites from the deciduous to the mixed dentition and (b) the development of new posterior crossbite cases during the eruption of the first permanent molars, in orthodontically untreated children., Materials and Methods: A cohort of pupils aged 4-12 years participated in annual dental screenings, from 2001 to 2019. Data were collected prospectively but examined retrospectively. Children were selected who had been initially screened in their deciduous dentition and on at least one consecutive year, presenting with a posterior crossbite in the deciduous or mixed dentition. Those with a posterior crossbite in the deciduous dentition were evaluated to see whether the crossbite persisted in the mixed dentition, and vice versa., Results: Of the 2571 children participating in the annual dental screenings, 1076 children were in the deciduous dentition at their first screening appointment, with 693 having attended at least two screening appointments. Of these 693 children, 70 had a posterior crossbite in the deciduous dentition (10.1%). The crossbite persisted in the mixed dentition in only 16 out of these 70 children. Twenty-six out of the 623 children who did not have a posterior crossbite in the deciduous dentition developed one in the mixed dentition., Limitations: The retrospective data collection, multiple examiners carrying out the dental screenings, and the absence of data on para-functions and oral habits were some of the limitations of the present study., Conclusions: In the present sample, 1 in 10 children have a posterior crossbite in the deciduous dentition, which is however autocorrected in about three-quarters of cases. On the other hand, 4% of children developed a new crossbite in the mixed dentition. It may thus be reasonable in cases with posterior crossbite in the deciduous dentition to wait for the first permanent molars to erupt before initiating treatment., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objectives: Patients with autism spectrum disorder (ASD) may be more predisposed to oral pathology, including dentoalveolar trauma. Our aim was to assess the risk of dentoalveolar trauma in patients with ASD., Materials and Methods: Meta-analysis methodology was used to compare the prevalence of dentoalveolar trauma in individuals with ASD compared to individuals without ASD. A literature search was carried out, with predefined inclusion and exclusion criteria, to identify controlled studies evaluating dentoalveolar trauma in individuals with ASD. Data were combined using the random-effects meta-analysis model., Results: Out of an initial 154 studies, 14 were selected for inclusion in the meta-analysis, resulting in a total of 1488 individuals with ASD. Meta-analysis results showed significant difference in the overall risk of dentoalveolar trauma between individuals with ASD versus a control group (RR = 1.45). Looking at specific types of dentoalveolar trauma, individuals with ASD were found to be more at risk for partial or total (avulsion) luxation injuries (RR = 3.02) than healthy individuals., Conclusions: Individuals with ASD are more at risk for dentoalveolar trauma than those without ASD, especially for more severe dentoalveolar trauma such as luxation and avulsion injuries., (Copyright © 2022 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Objectives: We aimed to investigate associations between sella turcica dimensions and maxillary growth in children with unilateral cleft lip and palate (UCLP)., Methods: Forty-nine patients with non-syndromic UCLP, prior to secondary alveolar bone-grafting, were included. The outcomes measured were sella turcica and maxillary cephalometric measurements, and scores representing dental arch relationships derived from dental casts. On lateral cephalograms, sella width, height, and area were measured, as well as maxillary length, height, protrusion, and inclination. Dental arch relationships were measured using the modified Huddart/Bodenham (MHB) scoring system, and translated GOSLON yardstick score. Multiple linear regression was used to assess associations between sella turcica measurements and either cephalometric parameters or MHB/GOSLON scores, including age and sex as covariables., Results: No significant associations were found between sella turcica dimensions and dental arch relationships. For cephalometric measurements, sella height and area were associated with basal maxillary length, alveolar maxillary length, and anterior maxillary height., Conclusions: Sella height and area seem to be predictors for both maxillary length and height as assessed cephalometrically, in a sample of patients with non-syndromic UCLP., Competing Interests: Declaration of Competing Interest All author declare that they have no conflict of interest., (Copyright © 2022 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Several systematic reviews have been published on the effects of mandibular surgery on condylar remodeling without reaching a consensus. The purpose of this systematic review of systematic reviews was to assess the impact of mandibular advancement or bimaxillary surgeries on condylar resorption. A literature search, using several electronic databases, was carried out by two reviewers independently. Article preselection was based on titles and abstracts, and final article selection based on full-text analysis of preselected studies. After final study selection, the quality of studies was assessed using the AMSTAR 2 tool. A decision algorithm was subsequently established to choose the best body of evidence. From an initial yield of 1'848 articles, 23 systematic reviews were identified for further analysis, with ten studies being included in the final selection. Despite the generally low quality of the reviews, certain associations could be made: young patients, female patients, and those with a high mandibular plane angle are more prone to condylar resorption following mandibular advancement osteotomies, especially if anterior rotation of the mandible is performed during surgery. Patients undergoing bimaxillary surgery also appear to have a higher risk of developing condylar resorption. In conclusion, these results confirm the multi-factorial nature of condylar resorption, stressing the need for well-controlled prospective studies with long-term follow-up to clearly identify potential risk factors associated with orthognathic surgery., (Copyright © 2022 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

The latest Eurocleft study reported several discrepancies in cleft care. Since then, no critical assessment has been performed. This study aimed to better understand the main strengths and inefficiencies of cleft care within Europe. The Google documents platform was used to create an online survey to investigate several aspects, i.e., provider characteristics, patient profile, services offered, and treatment protocols and complications. Descriptive statistics were calculated. The association between categorical variables was performed using Fisher's exact test. The significance level chosen was 0.05. A total of 69 individuals from 23 European countries completed the survey. Centralized care was the preferred system, and the majority of the countries have an association for cleft patients and professionals (53.6%). The largest percentage of patients was seen in the university hospital environment (Fisher's exact test p < 0.001). The majority of responders (98.6%) reported that an orthodontist was involved in cleft treatment, and 56.5% of them spend 76-100% of their time treating these patients. Despite cleft care having been reconfigured in Europe, a better consensus among the various centers regarding provider characteristics, services offered, and treatment protocols is still required. There is a need for better coordination between clinicians and national/international regulatory bodies.

(1) Background: Orthodontists have an important role in cleft care. Over the two decades since the Eurocleft studies, a significant improvement in healthcare systems has been achieved but there has been no critical assessment regarding the establishment of proposed standard protocols. This study aimed to describe the current provider characteristics, orthodontic appliances, services offered, orthodontic complications, and cost analysis of cleft treatment in Europe. (2) Methods: A cross-sectional 22-question online survey, accessible from January 2021 to July 2021, was sent to 214 practitioners, pertaining to provider characteristics, orthodontic appliances, services offered, orthodontic complications, and cost analysis. Descriptive statistics were calculated for each question. Fisher's exact test was used to assess the association between categorical variables. (3) Results: A total of 79 responses from 23 European countries completed the survey (response rate = 37%), with 69 surveys being assessed after the exclusion of incomplete surveys. Rapid maxillary expansion was the preferred expansion protocol (45%). Distraction osteogenesis was the most reported alternative treatment to secondary bone grafts (19%), with private practitioners being less likely to perform these treatments (Fisher's exact test, p = 0.001). Orthodontic services offered were, however, rather similar in the various locations of provision (hospital and/or university, private). Compromised oral hygiene (77%) was the most reported orthodontic complication. The National Health Services support the majority of cleft orthodontic care (67%) in Europe. (4) Conclusion: An apparent improvement in orthodontic healthcare provision has been achieved within Europe in the last two decades, but there are several discrepancies, namely regarding treatment timing and the appliances offered.

Objectives: To perform an epidemiological analysis of the antegonial notch depth in postpubertal individuals and to analyze the development of deep antegonial notches longitudinally in growing individuals. MATERIAL AND METHODS: Lateral cephalograms of 302 untreated 17/18-year-old subjects (171 males; 131 females), from the craniofacial growth legacy collection, were analysed to measure antegonial notch depth along the mandibular plane. Sex and sagittal malocclusion were investigated as possible factors influencing notch depth. In subjects with deep antegonial notches (>1.5 standard deviation) at the age of 17/18 years, earlier lateral cephalograms at 7/8 and 13/14 years were obtained, and the magnitude of notch depth analyzed longitudinally. Linear regression analyses were used to assess correlations between antegonial notch depth and other recorded variables., Results: Antegonial notch depth ranged from 0 to 5.3 mm (mean 2.0 ± 1.0 mm). Antegonial notches were significantly deeper in males (2.3 ± 1.1 mm) than females (1.5 ± 0.7 mm) (p < .001). Notch depth was on average 0.3 mm deeper in Class I than in Class II or III individuals (p = .019). Twenty-one subjects (all male) were judged to have deep antegonial notches at the age of 17/18. In these subjects, notch depth deepened from 13/14 to 17/18 years (p < .001), whereas no change was observed between 7/8 and 13/14 years., Conclusions: Antegonial notch depth shows important variation in postpubertal individuals, with males having deeper notches than females on average. In those with deep antegonial notches (all males in the present sample), notch depth increases not during prepubertal growth but during the pubertal growth spurt., (© 2022 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Objective: To evaluate final posttreatment occlusion in patients with complete unilateral cleft lip and palate (cUCLP) by comparing (1) 3 treatment centers, (2) males and females, (3) cleft and noncleft sides, (4) right- and left-sided clefts, and (5) orthodontic treatment with/without orthognathic surgery (OS)., Design: Retrospective cohort study., Patients: Blinded posttreatment dental casts of 56 patients (19.4 ± 1.4 years) with cUCLP from 3 centers in Switzerland., Main Outcome Measure: Occlusal assessment using the modified Huddart/Bodenham (MHB) index., Results: Our sample comprised 35 males and 21 females, 46 with left- and 10 with right-sided clefts, of which 32 had undergone OS. The final posttreatment occlusion showed a median MHB score of 0 (interquartile range: -1.0 to 2.0) in the total sample and did not seem to depend on treatment center, sex, or OS. The MHB scores for the anterior buccal and the buccal segments were more negative on the cleft than on the noncleft side ( P = .002 and P = .006, respectively). When the cleft was on the left side, the MHB score tended to be more positive in the labial ( P = .046) and anterior buccal segments ( P = .034)., Conclusions: This study shows a very satisfactory final posttreatment occlusion in patients with cUCLP. The more constricted buccal occlusion on the cleft side emphasizes the attention that should be given in correcting the more medially positioned lesser maxillary segment. The influence of cleft-sidedness should be analyzed further on a sample including more patients with right-sided clefts.

Objective: To document and analyze the overall longitudinal institutional treatment experience of children with nonsyndromic Robin sequence (RS) from infancy to early adulthood., Design: Retrospective longitudinal treatment review., Setting: A tertiary-care, referral, teaching hospital., Patients: Children with nonsyndromic RS and cleft palate (N = 117) born between December, 1985, and January, 2012., Interventions: Data regarding airway management, nutritional management, audiological interventions, orthodontic treatment, and surgical interventions were documented and analyzed in different growth/developmental stages. Comparative data from other international centers were collected from the literature., Results: Airway management during infancy involved prone positioning (92%), nasopharyngeal airway (6%), tracheostomy (2%), and mandibular distraction osteogenesis (1%). Feeding with nasogastric, gastrostomy, and/or gastrojejunostomy tubes was used in 44%, Haberman feeders in 53%, and Mead Johnson feeders in 3%. Gastroesophageal reflux disease was documented in 6% of the sample. During childhood and early adolescent years, pharyngeal flap surgery was carried out in 22% of the children, while 11% had secondary palatal surgery. Audiological management included the use of tympanostomy tubes in 62%, with several children needing multiple tube replacements. At least 18% were diagnosed with obstructive sleep apnea. Adenoidectomy or adenotonsillectomy was undertaken in 4%. Analysis of data pertaining to middle childhood and adolescent years showed that orthodontic treatment was conducted for most children for crowding, tooth agenesis, and skeletal and/or dental dysplasia. Orthognathic surgery frequency (<18%) was low., Conclusions: Institutional treatment experience of children with nonsyndromic RS involves multidisciplinary care at different ages and stages of their development.

Background: Masseter muscle thickness and its relationship with vertical craniofacial morphology have been extensively studied in adults, but data on children are lacking., Objective: To examine the association between masseter muscle thickness and vertical cephalometric parameters in a group of Class II malocclusion growing children., Methods: The current study design was retrospective and cross-sectional, looking at a sample of 211 growing children with Class II malocclusion between the ages of 6 and 15 derived from two centers. Ultrasonographic masseter muscle thickness measurements and vertical cephalometric variables, including the gonial angle, were evaluated before any orthodontic treatment had been carried out. Multiple linear regression analysis was used to examine the association between masseter muscle thickness and vertical cephalometric measurements, including age and patient origin as independent variables in the analysis., Results: In the present sample, masseter muscle thickness was found to be independent of sex, but correlated with age, with older children presenting thicker masseter muscles. In the total patient sample, using multiple regression analyses, children with thicker masseter muscles had significantly smaller intermaxillary and gonial angles. No other cephalometric vertical characteristics showed associations with masseter muscle thickness., Conclusion: In growing children with Class II malocclusion, those with thicker masseter muscles are more likely to display smaller intermaxillary and gonial angles respectively., (© 2022 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

The purpose of the present study was to evaluate the association between initial TMJ examination findings and clinical and MRI severity of TMJ arthritis in a cohort of patients with JIA. The clinical variables were signs and symptoms at the initial TMJ evaluation. Outcome was the severity of TMJ arthritis as evaluated clinically by the Helkimo clinical dysfunction indices and by MRI. Associations of signs and symptoms with clinical and MRI severity were analyzed using a Fisher exact test and linear regression. The sample was composed of 101 patients with a mean age of 12.8 years, 76% of which were girls. Subjective difficulty in opening the mouth wide and objective limited MIO were the only clinical findings associated with both the severity of clinical dysfunction (p = 0.001 and p < 0.001, respectively) and the acute (p = 0.008 and p = 0.001, respectively) and chronic (p = 0.006 and p = 0.001, respectively) MRI severity of the TMJ arthritis. The results of this study suggest that in patients with JIA, limited mouth opening at the initial TMJ assessment may be a valid indicator of clinical severity of TMJ arthritis, which correlates with severity as seen on MRI., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Head posture is a balance of several positions and therefore shows inherent variation. Most methods available to quantify this are however instantaneous, not providing information about its variation over time. A dynamic recording of head posture would thus be beneficial., Objectives: The purpose of this study was to evaluate the variation in natural head position (NHP) over 5 min using an inertial measurement unit (IMU)., Methods: Fifteen healthy young volunteers were asked to sit on a chair and keep their head in the self-balanced position for 5 min. A mirror was then revealed in front of them, and they were asked to look at their eyes for 20 s. This procedure was undertaken on two separate occasions with a one-week interval. This was compared to an instantaneous measurement of head position at a specific time point corresponding to the 15th second of the recording., Results: During the 5 min of recording, the participants tended to elevate their head progressively by a mean of 1.5°, which is then corrected by looking at oneself in the mirror. Most participants tended to rotate their head to the left and continued that progressive rotation despite looking in the mirror. The roll axis had no systematic changes observed between the self-balanced position and the mirror-guided position and was the most reproducible axis. Moderate to good correlations were found comparing both sessions for each axis., Conclusion: The comparison between the five-minute analysis and the instantaneous measurement showed a systematic difference on the pitch axis but no differences for the yaw and roll. These results suggest that the variation in the NHP during a period of 5 min is generally specific to each participant with a head elevation and rotation to the left in most cases., (© 2022 The Authors. Journal of Oral Rehabilitation published by John Wiley & Sons Ltd.)

Aim: To investigate if treatment outcome in patients with Class II division 1 malocclusion treated by a variety of approaches is affected by masticatory muscle capacity., Materials: Seventy-four children with Class II division 1 malocclusion were included in the present study. These were divided into 54 children (10.4 ± 1.6 years of age) treated with fixed appliances including headgear and/or Class II intermaxillary elastics, 12 children (9.9 ± 1.9 years of age) treated with functional appliances and 8 children treated with fixed appliances and other means of treatment. Ultrasonographic masseter muscle thickness measurements were taken before treatment, while lateral cephalograms were taken before and after treatment., Statistics: Multivariate linear regression analysis was used to assess the association between masseter muscle thickness and treatment outcomes, as well as the gonial angle and treatment outcomes., Conclusion: In children with Class II division 1 malocclusion treated by means other than functional appliances, treatment outcome is not associated with masseter thickness. This may be the case since the application of intermaxillary forces and torque application may offset the functional component in tooth movement. Outcomes following functional appliance treatment may be partly determined by the masticatory muscles. During functional treatment, children with a weaker masticatory system show greater dentoalveolar compensation. This is however not maintained during the second phase of fixed appliance treatment.

Aim: To investigate differences in sella turcica size and bridging in children with unilateral cleft lip and palate (UCLP) with or without concomitant dental anomalies., Patients and Methods: A cross-sectional study was carried out looking at 56 children with nonsyndromic UCLP. Lateral cephalograms, taken before alveolar bone grafting, were used to assess sella turcica height, width, area, and bridging. Panoramic radiographs were used to evaluate the presence of dental anomalies in the cleft area including agenesis, supernumerary, and peg-shaped lateral incisors. Differences between sella turcica measurements in the presence or absence of dental anomalies were assessed using t tests. Differences between the prevalence of dental anomalies and sella turcica bridging were assessed using χ 2 and Fisher exact tests. Multinomial logistic regression was used to investigate potential associations between sella measurements and dental anomalies., Results: Twenty-six of the 56 children presented with agenesis of the cleft-side lateral incisor, while 7 had a supernumerary, and 19 had a peg-shaped lateral incisor. With regard to sella turcica bridging, 27 children had no calcification, 25 partial and 4 complete calcification. Children with agenesis of the cleft-side lateral incisor showed a shorter sella maximum height ( P = .010) and a smaller area ( P = .019). When looking at sella turcica bridging, 100% of children with complete calcification showed agenesis of the cleft-side lateral incisor, compared with 52% and 33% of children with partial calcification and no calcification, respectively ( P = .034)., Conclusions: Children with UCLP and sella turcica bridging are more likely to present with agenesis of the cleft-side maxillary lateral incisor.

An inertial measurement unit (IMU) is an electronic device that measures and track the orientation of a body. We conducted this study in accordance with the STARD guidelines to evaluate the accuracy of IMU (index test) for measuring head posture compared to the current gold standard using a cervical range of motion (CROM) device. The reproducibility of the hunter and mirror-guided head posture was also evaluated. In vitro and in vivo tests were carried out to assess the validity of the IMU. To assess reproducibility, thirty healthy young adults were asked to look at four different locations in two different sessions while the head posture was recorded. Excellent correlation (r = 0.99; p < 0.001) was found between the IMU and CROM device with an absolute mean difference of 0.45° ± 0.58° (p = 0.85) for the in vitro test and 0.88° ± 1.20° (p = 0.99) for the in vivo test. For the reproducibility test, moderate to good correlation coefficients were found (r = 0.55 to 0.89; all p < 0.05) between the two sessions. The intraclass correlation coefficient ranged from moderate to excellent reliability (ICC from 0.74 to 0.96). These results suggest that the IMU sensors, when calibrated correctly, can be adequate to analyze head posture., (© 2021. The Author(s).)

Objective: To evaluate the potential influence of muscular capacity and facial morphology on facial expressions in children., Materials and Methods: A cross-sectional study was carried out on 40 healthy children (ages 9-13), without previous orthodontic treatment. Masseter muscle thickness and anthropometric facial proportions were measured using ultrasound and digital calipers respectively. A three-dimensional infrared face-tracking system was used to register facial expressions. The maximal amplitude of smile and lip pucker (representing maximal lateral and medial commissure movement) were used for analysis. Stepwise regression was used to investigate whether muscle thickness or anthropometric facial proportions were associated with the quantity of commissure movement., Results: When performing maximal smile, children with thicker masseter muscles were found to have more limited displacement of the commissures (R = 0.39; p = 0.036). When performing lip pucker, children with thicker masseter muscles were found to have greater commissure movement (R = 0.40; p = 0.030). No significant associations were found between anthropometric facial proportions and facial expressions., Conclusion: Masseter muscle thickness seems to be associated with facial expressions in children. Those with thicker muscles show more limited commissure movement when smiling, but greater movement with lip pucker. This indicates that masticatory muscles may serve as a surrogate for mimic muscle activity. Facial morphology of the subjects does not seem to be associated with facial expression., (© 2021 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Aims: The purpose of this study was to compare the natural head position (NHP) in the sitting position to the NHP in a standing position using inertial measurement unit (IMU) and lateral photographs., Matierials & Methods: Twenty healthy young adult volunteers were asked to look at a mirror located at 1 metre in front of their eyes while being recorded with the IMU system. Lateral photographs were also taken. This procedure was undertaken for the standing and sitting positions, on two separate occasions within a one-week interval., Results: A strong correlation was found between the IMU system and the lateral photographs (r > .99) with regard to the pitch axis, the absolute mean difference was 0.4 ± 0.5 (p = .99) for both standing and sitting positions. We found that in the sitting position the head was elevated by 2.5 ± 2.4 (p < .05) more than in the standing position, but no significant differences were observed for the other two axes (roll and yaw)., Conclusion: The IMU system is comparable to lateral photographs for pitch assessment. Except for a slight elevation of the head in the sitting position, no clinical differences were observed for the NHP when comparing the standing and sitting positions., (© 2021 The Authors. Journal of Oral Rehabilitation published by John Wiley & Sons Ltd.)

The dental, skeletal, and soft-tissue characteristics of a particular malocclusion can differ based on ethnicity, race, age, sex and geographical location with Class II malocclusion being one of the most prevalent malocclusions encountered in orthodontic clinical practice. The broad understanding of the characteristics of vertical skeletal and dental parameters in patients with Class II malocclusion can help clinicians to identify patterns and variations in the expression of this phenotype for better treatment outcomes. Hence, we compared the craniofacial characteristics of skeletal and dental Class II malocclusion traits from Indian and Vietnamese individuals to analyze the vertical skeletal and dental patterns in both population groups. The sample comprised of lateral cephalograms from 100 young adults with Class II malocclusion, of which fifty (25 males and 25 females) were from South India and the other 50 age- and sex-matched adults from Vietnam. The lateral cephalometric radiographs were digitized into anonymous image files and were traced and assessed for 16 vertical skeletal and dental parameters. The ANB angle was greater in males (+1.4 deg; p < 0.001) and females (+1.9 deg; p < 0.001) in the South Indian population. The Vietnamese males had a larger mandibular plane angle, articular angle, anterior facial height and lower anterior facial height compared to the Indian males. The Vietnamese females had larger mandibular plane and articular angles compared to the Indian females. The skeletal class II malocclusion was more severe in the South Indian compared to the Vietnamese adults. The Vietnamese sample showed a generalized tendency towards a more vertical skeletal growth pattern and in males this pattern seemed to be due to the dentoalveolar component. The Vietnamese females showed a tendency towards a vertical growth pattern, but without apparent contribution by the dentoalveolar component.

Objectives: The aims of this study were: 1. to evaluate the experience of pain perceived by children during separator placement and headgear wear; 2. to find possible associations between the perceived intensity of pain and the levels of Substance P (SP) and interleukin-1 beta (IL-1β) in the gingival crevicular fluid (GCF) during these procedures; 3. to identify other factors, such as previous pain experience, which could be associated to the patients' perceived discomfort or pain during treatment., Trial Design: Nine-month parallel-group randomized controlled trial., Methods: Forty Class II malocclusion children (8-12 years) were included, half of which received a cervical headgear while the other half did not receive any treatment during the study period. Baseline pain data were recorded including previous experience to general and dental pain, Corah's Dental Anxiety Scale, and baseline pain using a visual analogue scale (VAS). Elastic separators were placed in children for 1 week, followed by molar band and cervical headgear placement. Children were seen at various time points throughout the 9-month period where at each appointment, a VAS assessment of pain as well as GCF sampling was carried out to quantify the levels of SP and IL-1β. Multiple regression analysis was performed to ascertain the influence of factors including sex, age, time, headgear wear, and baseline pain data on pain severity., Results: Pain severity and SP and IL-1β levels in the GCF follow a similar pattern, with peaks being observed 1 day after orthodontic elastic separator placement. Pain was more severe after the placement of orthodontic separators than following cervical headgear wear. With regard to pain predictors, pain is more severe in older children, those with a worse previous general pain experience, and those with higher levels of IL-1β, particularly after elastic separator placement., Conclusions: Orthodontic pain and discomfort following orthodontic separator placement and cervical headgear wear depends on factors including age, previous pain experience, and the level of IL-1β in the GCF., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Individuals with special healthcare needs have increased orthodontic treatment need, but access to care may be insufficient. The aim of this study was to assess the uptake of patients with special needs in orthodontic settings throughout Switzerland. A web-based survey was sent to all specialist orthodontist members of the Swiss Orthodontic Society. From 220 questionnaires sent, 60% were returned (n=131). 84% of participants responded that they treat patients with special needs, but most orthodontists saw only two new patients per year with special needs. Patients most frequently treated were those with Down syndrome, autism spectrum disorder, or intellectual deficiency. Many practitioners use fixed, removable or functional appliances for treatment of these patients, while aligner use was much less prevalent. Interceptive measures were also used. Chairside time was increased on average by 50%, and treatment duration increased by 25% when compared to other patients. Treatment goals for about half of these patients was compromised. Of orthodontists not providing treatment to individuals with special needs, 79% stated they would not be interested in treating these patients, while 56% of orthodontists already providing treatment stated they would not be interested in treating more of these patients. Reasons given included the lack of additional strategies to treat these patients, lack of referrals, problems with cooperation, and time constraints. In conclusion, roughly four in five orthodontists in Switzerland treat patients with special needs, with most of these orthodontists seeing one or two new patients with special needs annually. The majority of practitioners do not wish to increase their intake of patients with special needs.

Introduction: Appreciation of the soft-tissue profile is important in orthodontic diagnosis and treatment. However, are the patients themselves aware of their profile appearance? We aimed to evaluate if age influences self-perception of the soft-tissue profile in children., Methods: The study population for this prospective cross-sectional investigation consisted of 3 groups of 60 patients, classified according to age (<12 years; 12-15 years; >15 years). Each subject's right-sided facial profile was photographed to obtain a silhouette. Facial profile silhouette templates were created to represent the local population. Each subject's photograph was inserted into the corresponding template, and the subjects were asked to identify themselves. Facial profile self-recognition was recorded as a binary variable (yes or no). Other recorded variables included age, sex, and sexual maturity rating (using Tanner staging). Chi-square tests were used to analyze facial profile self-recognition between different subgroups, and stepwise multiple regression was used to predict the probabilities of facial profile self-recognition, with age, sexual maturity rating, and other recorded variables as independent variables., Results: Eighty percent of subjects aged >15 years recognized their own profile, compared with only 55% and 50% of subjects aged 12-15 years and <12 years, respectively. Subjects aged >15 years were significantly more likely to recognize their profile than younger subjects (P = 0.001). Similarly, subjects with the most advanced sexual maturity rating (stage V) were significantly more likely to recognize their profile (85% self-recognition) than those in groups I-IV (P <0.001). Girls were more likely to recognize their profiles than boys (P = 0.028). When using multiple regression analysis, sexual maturity rating appears to be the only significant predictor for facial profile self-recognition (R 2  = 0.25; P <0.001)., Conclusions: Facial profile self-recognition seems to improve with age and sexual maturity (sexual maturity rating stage V). Because orthodontic treatment planning takes possible soft-tissue changes into account, it is important to evaluate the degree of self-perception of the patients to adapt our goals and treatment discussions., (Copyright © 2020 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: To determine the prevalence and distribution of clinically missing permanent incisors, and the age at which they are detected, in school-aged children., Methods: A total of 2573 children aged 4-13 underwent oral health screening on at least one occasion between 2001 and 2017. In order to define a threshold age, after which permanent incisor agenesis could be suspected clinically with reasonable certainty, children who had been seen for at least three consecutive years, with any clinically missing permanent incisor were selected (n = 19). The maximum age of detection among these children was chosen as the threshold age. Based on this, a total of 766 children at or above the threshold age were screened for a cross-sectional epidemiological survey. Chi-squared tests were used to compare the prevalence of clinically missing permanent incisors among boys and girls, comparing unilateral versus bilateral, and right- versus left-sided missing teeth., Results: Roughly 2% of the sample presented with at least one clinically missing maxillary lateral incisor. This was bilateral in half of cases. Clinically missing mandibular incisors were found in 0.5% of children. Finally, the threshold age for clinical suspicion of maxillary lateral incisor agenesis was set at 11.5 years. Agenesis was confirmed in all of the children attending a follow-up radiographic visit., Conclusions: Approximately 1 in 50 children present with a clinically missing maxillary lateral incisor. The age at suspicion of maxillary lateral incisor agenesis can sometimes be several years after its expected eruption, perhaps due to significant variation in eruption times., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objectives: To evaluate the spontaneous eruption potential of impacted human permanent teeth localized in the anterior part of the maxilla, after the surgical extraction of obstacles in their eruption pathway, by means of a systematic review and meta-analysis., Materials and Methods: A systematic literature search was carried out to locate studies reporting on the percentage of anterior permanent teeth erupting after surgical removal of the obstacle, without other interventions. Eruption potential of impacted teeth was calculated using a random-effects meta-analysis. Information about the sex proportion, follow-up duration, age and years during which the study was carried out was used for subgroup analyses., Results: A total of twelve studies were included, with a total sample size of 960 cases and a follow-up period of up to 36 months. The results show that more than 65.5% of impacted teeth erupt spontaneously following surgical extraction of the obstacle, with an odds ratio of 4 (95% CI 1.9, 8.2) (p < 0.001) favouring spontaneous eruption., Conclusions: When faced with an impacted maxillary anterior tooth, surgical extraction of the obstacle can lead to spontaneous eruption of the impacted tooth in the majority of cases, with better success with a longer follow-up for up to 3 years., Clinical Relevance: Based on the present meta-analysis, clinical recommendation would be to surgically remove the obstacle impeding the eruption of a maxillary anterior permanent tooth and wait for the eruption of the tooth for a period of 12-36 months, depending on the age of the patient.

Objective: To use morphometric methods to investigate the size and shape of the sella turcica in children with unilateral cleft lip and palate (UCLP)., Setting and Sample Population: Fifty-six healthy children with non-syndromic UCLP, from a major paediatric teaching hospital, with lateral cephalograms taken prior to alveolar bone grafting, were compared with an age- and sex-matched control group of healthy children without orofacial clefts, with lateral cephalograms taken prior to orthodontic treatment., Materials and Methods: In this cross-sectional study, conventional measurements were performed on the sella turcica to measure width, height and area on lateral cephalograms. Sella shape was also analysed using 11 points defining the sella turcica contours, using geometric morphometrics. Procrustes superimposition was used to register all sella contour tracings to calculate average sella shape. Principal component analysis was applied to the residuals of the point coordinates, and principal components (PCs) of shape were extracted., Results: Statistically significant differences between the UCLP and control groups were found for sella posterior height, midpoint height, maximum height and area, where all of these were smaller in children with UCLP. Principal component analysis revealed that the first two PCs accounted for 84.7% of total shape variance. There was a statistically significant difference in sella shape between children with UCLP and control children., Conclusions: In children with UCLP, the sella turcica is shorter and with a smaller surface area when compared to matched non-cleft children. Moreover, sella turcica shape, when disregarding size, seems to differ to that of non-cleft children., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose: The objective of this study was to investigate the effect of temporomandibular intra-articular corticosteroid injections (IACS) on pain and mouth opening in children with juvenile idiopathic arthritis (JIA) with temporomandibular joint (TMJ) involvement., Methods: Systematic review and meta-analysis methodology was used, beginning with a comprehensive literature search using MEDLINE, PubMed, EMBASE, Web of Science, and the Cochrane library. The population in question was pediatric patients with a JIA diagnosis and TMJ involvement; the intervention was IACS injections to treat TMJ arthritis; a strict control group was not considered necessary; the outcome was clinical signs of improvement of the TMJ arthritis based on pain and mouth opening capacity (MIO). Data on pain and MIO were extracted from the selected studies, and the methodological quality of studies was assessed according to the ROBINS-I tool. Results from the different studies were combined to calculate the pooled proportion with 95% confidence intervals (CIs) for pain resolution, and pooled mean differences with 95% CIs for improvement in MIO. Heterogeneity of the results among studies was tested using I 2 statistics., Results: The initial search yielded a total of 330 articles; 11 of these were selected for inclusion in the review. 325 participants were included from the combined studies, with the mean age of participants ranging from 5.3 to 13.6 years. Between 24 and 137 TMJs were selected for each of the studies. The pooled proportion of patients with pain resolution following IACS injection was 78% (95% CI: 59-90%), with large heterogeneity (I 2  = 62%). The pooled gain in MIO following IACS injection was 4.38 mm (95% CI: 2.76-6.00), also with high heterogeneity (I 2  = 67%)., Conclusions: The results suggest that in children diagnosed with JIA with TMJ involvement, IACS injections can help in reducing reported pain and improving mouth opening capacity, albeit with an important variation between studies., (Copyright © 2020 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Subjects affected by Duchenne muscular dystrophy (DMD) develop severe malocclusions with the progression of the disease, due to changes in orofacial musculature and function, including tongue hypertrophy. We aimed to evaluate the benefits of maintaining mandibular interarch width with the help of a simple fixed orthodontic appliance. Three adolescent DMD boys were selected consecutively to receive a passive rigid mandibular lingual arch, and followed for 4-5 years. An untreated age-matched control group was chosen and followed for a similar period. Study casts were obtained at baseline and after follow-up. Outcomes measured were overjet, overbite, maxillary and mandibular intermolar widths, mandibular arch depth, molar relationships, and the presence of lateral crossbites and anterior or lateral openbites. Changes in measurements obtained between the two time points were compared in each age-matched pair. There was a clinically important increase in the mandibular intermolar width in the non-treated children ranging from 2.5 mm to 9 mm, but not in those treated. Malocclusions generally deteriorated in untreated children while they remained stable in treated children. The use of a rigid mandibular lingual arch in boys with DMD can help slow down the rapid deterioration of the developing malocclusions that accompanies the progression of the disease., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Minor cranial sutural synostosis is currently regarded as a rare diagnosis. As clinical awareness grows, a greater number of cases are being documented. This study aims to describe the variants of unicoronal synostosis with regard to major and minor sutural involvement and secondary effects on cranial and orbital morphology. The information is aimed to improve clinical diagnosis and management., Methods: A retrospective study was conducted collecting preoperative computed tomographic scans of patients diagnosed with unicoronal synostosis and listed for surgical interventions, identified from a craniofacial database. Within these patients, different synostotic variants were identified based on which suture was affected. Scans of normal pediatric skulls (trauma) were used for a control group. Computed tomographic scans were analyzed for sutural involvement, cranial base deflection, and ipsilateral and contralateral orbital height and width. One-way analysis of variance was used to detect differences between synostotic variants and controls., Results: A total of 57 preoperative computed tomographic scans of patients with unicoronal synostosis were reviewed, in addition to 18 computed tomographic scans of normal skulls (control group). Four variants of unicoronal synostosis were identified: frontoparietal, frontosphenoidal, frontoparietal and frontosphenoidal, and frontosphenoidal and frontoparietal. The last two variants differ in their temporal involvement in the direction of sutural synostosis and ultimately cranial and orbital morphology. Three variants have been previously identified, but the fourth is presented for the first time., Conclusions: An understanding of the variants of unicoronal synostosis and their temporal relationships is integral for accurate clinical diagnosis and surgical correction. Recommendations for treatment are based on discrete changes in orbital morphology.

Objective: To accurately describe compliance in headgear wearing time by using a temperature- and force-sensitive device over an 8 month period of use in a prospective clinical manner., Materials and Methods: Twenty children with Class II malocclusion aged 8-12 years were randomly selected for treatment with cervical headgear. The headgears were equipped with an electronic module, which measured temperature and force, and patients were instructed to wear the headgear 12 hours daily. The recorded values were analysed to determine the number of days the headgear was used, the number of hours per day it was worn, and the percentage of compliance (100 per cent corresponding to 12 hours daily)., Results: The average treatment period was 8.4 months with 5.8 months of effective use. When effectively used, headgear was worn 8.7 hours a day (compliance of 73 per cent). Including days where it was not worn, compliance was 6.4 hours (54 per cent). The appliance was used on average 0.5 hours during the day (8 am-8 pm) and 5.9 hours during the night (8 pm-8 am). Very low compliance was recorded during July and August., Conclusion: The average compliance with cervical headgear use was 54 per cent of the 12 hour prescription. The headgear was effectively used only 5.8 months over the study period, with roughly 30 per cent of no use. Headgear was used almost exclusively during evening and night-time. During the summer period, compliance was particularly poor., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)