Paediatric endocrine disorders represent a spectrum of conditions that affect hormone synthesis, regulation and function in childhood and adolescence. They present with intraoral features that may compromise the long-term well-being and oral health of affected individuals, potentially persisting into their adult years when appropriate diagnosis and therapeutic intervention are delayed or inadequate. This study aims to determine the prevalent oral manifestations of endocrine disorders among children attending the Paediatric Endocrinology Clinic of the Lagos University Teaching Hospital (LUTH). A cross-sectional study was done among 50 paediatric patients aged (6-18 years) with endocrine disorders, recruited via consecutive sampling. Data collection employed interviewer-administered questionnaires covering medical and dental histories, followed by standardized intraoral examinations of soft and hard tissues. Ethical approval, informed consent, and participant assent were obtained. Data was analysed using SPSS version 25. Descriptive statistics included frequencies and percentages. Inferential analysis was performed using Chi-square test to evaluate associations between categorical variables. Statistical significance was set at p < 0.05. Type 1 diabetes mellitus was the predominant condition among the participants (n = 27, 54.0%), followed by hypothyroidism (n = 7, 14.0%). Other endocrine disorders, including congenital adrenal hyperplasia (n = 6, 12.0%), Turner syndrome, Cushing syndrome, adrenal insufficiency, and metabolic syndrome, were each represented by single cases (2.0% each). Oral dryness emerged as the leading soft tissue manifestation (n = 27, 54.0%), accompanied by oral pigmentation (n = 20, 40.0%), gingivitis (n = 7, 14.0%), and oral ulceration (n = 6, 12.0%). Enamel defects, crossbite, dental crowding, open bite, and dental caries were the primary hard tissue findings, each occurring in eight participants (n = 8, 19.0%). There is a significant prevalence of oral pathologies among paediatric patients with endocrine disorders. Findings support incorporating dental evaluations into endocrinological care protocols and highlight the need for coordinated inter-professional management involving endocrinologists, paediatric dentists, and orthodontists.

BackgroundThis study evaluated the influence of clinical periodontal, radiological, and demographic factors on gingival margin migration after fixed orthodontic treatment using linear mixed model analysis, with separate assessments of labial and lingual surfaces.MethodsThis retrospective single-cohort study analyzed pre and post treatment changes in 88 patients who underwent orthodontic treatment without a non treated control group. Patients were periodontally healthy based on the absence of bone loss on panoramic radiographs and three dimensional intraoral scans. The mean age was 19.25 ± 7.46 years, and measurements were performed on mandibular anterior teeth. Clinical crown length and keratinized tissue width were measured using three dimensional intraoral scans, and cephalometric variables were obtained from lateral radiographs. Gingival margin migration was defined as the change in clinical crown length from before to after treatment. Predictor variables included dental crowding, alveolar ridge width, incisor mandibular plane angle, gonion–menton–sella–nasion angle, symphysis morphology, age, sex, treatment duration, and keratinized tissue width. Linear mixed models were used to assess gingival margin migration across all surfaces and separately for labial and lingual surfaces, using baseline and treatment related changes as predictors.ResultsOf 530 screened patients, 88 were included (72% female). In baseline models, keratinized tissue width, dental crowding, and sex were significant predictors of gingival margin migration. Lingual migration was additionally associated with incisor mandibular plane angle, symphysis morphology, and age. On the labial surface, incisors showed more coronal gingival margin position than canines relative to baseline. In models based on treatment related changes, keratinized tissue width, dental crowding, and age were consistent predictors across all surfaces. Labial margins showed more coronal position than lingual margins, while lingual migration was negatively associated with changes in incisor mandibular plane angle. Changes in keratinized tissue width had the strongest effect.ConclusionsBaseline keratinized tissue width and its increase during treatment were the strongest predictors of gingival margin stability. Dental crowding, incisor inclination, and symphysis morphology showed surface and tooth specific effects, whereas alveolar crest width had no significant impact.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12903-026-08756-y.

BackgroundDental crowding affects nearly half of European adolescents and can negatively impact oral health-related quality of life (OHRQoL), particularly emotional and social well-being dimensions. Orthodontic treatment aims to improve function, aesthetics, and psychosocial well-being, yet active treatment may temporarily impair OHRQoL due to pain, dietary restrictions, and oral hygiene challenges. Understanding how conditions affect patients requires both objective and subjective assessments, yet patient reported outcomes remain underreported in orthodontic research, especially when comparing treatment techniques.ObjectivesTo evaluate and compare OHRQoL, treatment motivation, expectations, quality of care and attention, and satisfaction in adolescents with dental crowding treated with two fixed appliance systems without extractions, and to explore factors associated with satisfaction with treatment outcomes.Trial designMulticentre, two-arm, parallel-group, superiority randomized controlled trial, with pooled analyses of both treatment groups, sex-stratified comparisons, and analyses exploring associations.MethodsAdolescents (n = 132), 12–17 years, with dental crowding were randomized with 1:1 ratio using computer generated random permuted blocks, stratified by sex, to receive fixed appliance treatment without extractions with either a conventional bracket system (CB; Victory) or a passive self-ligating bracket system (PSLB; DamonQ) at four orthodontic clinics. Primary outcome was Child Perceptions Questionnaire 11-14 (CPQ) score change. Two items were omitted; sensitivity analysis confirmed minimal impact on results. Secondary outcomes were patient experience and satisfaction questionnaires (10-point scale) assessed before treatment (T0), post-alignment (T1), and post-treatment (T2). Because of the nature of the treatments, only assessors could be blinded.ResultsBoth the CB (♀39, ♂31) and PSLB (♀34, ♂28) groups reported improved OHRQoL (median CPQ score change T0-T2 for total sample: 4.5; r = 0.37, P < .001) with minor intergroup differences. Oral symptoms and functional limitations worsened at T1 then improved by T2 (median change T0–T2 for each domain: 1, r = 0.23, 0.27, respectively, P < .001), whereas emotional and social well-being improved throughout treatment (median change T0–T2 for each domain: 1; r = 0.28, P < .001). Median scores were high for motivation (9) and overall satisfaction with treatment outcomes (≥9), and low for regretting having started treatment (1). Correlations between treatment expectations and satisfaction were observed (ρ = 0.330, P < .001). Minor harms expected during orthodontic treatment included plaque accumulation, chafing and gingivitis.ConclusionsThis study indicates that fixed appliance treatment for dental crowding leads to improvements in OHRQoL, with temporary declines during treatment, and high patient satisfaction in the studied sample. Patients reported satisfaction with the changes achieved, dental appearance, and did not regret having started treatment. The results demonstrate possible benefits of treatment, patient-centred care, and support the use of patient reported outcomes in orthodontic practice.Trial registrationClinicalTrials.gov (NCT05664282) 2022-11-24.

Dental malocclusions are common and often underdiagnosed situations in dogs, which might result in oral trauma, impaired mastication, and periodontal disease. Nevertheless, scientific investigations into breed-specific variations in dentition remain scarce. To evaluate breed-specific dental variations in dogs, a retrospective cross-sectional analysis was conducted on 92 clinical canine head computed tomography (CT) scans obtained in Chengdu, China, representing a range of breeds and skull morphologies. Dental alignment and occlusal relationships were calculated using standardized malocclusion classification criteria. As a result, malocclusions were found and identified in 46.7% of dogs. Among them, brachycephalic breeds indicated a high prevalence of malocclusion, with Shiba Inu dogs demonstrating the highest malocclusion rate (66.7%), whereas Golden Retrievers and Akitas showed the lowest prevalence (16.7%). Class I malocclusions characterized by dental crowding were most common (44.19%), followed by Class II malocclusions (overbite) (30.23%), and Class III malocclusions (underbite) (20.93%). Our findings demonstrated a strong association between skull morphology and dental alignment abnormalities.

Breastfeeding is associated with infant health benefits, such as a reduced risk of infections, obesity, and diabetes, and offers protection against breast and ovarian cancer in mothers. However, its possible relationship with dental caries and malocclusions has recently been suggested. The present umbrella review assessed the relationship between breastfeeding and oral health. This umbrella review evaluated the relationship between breastfeeding and oral health in individuals under 18 years of age by systematically reviewing studies available in databases such as PubMed, Scopus, Web of Science, and others. The Mantel-Haenszel method was used to calculate odds ratios (OR) with 95% confidence intervals. Eighteen reviews on caries, malocclusions, bone mass, muscle function, and cleft lip/palate were analyzed. Breastfeeding was found to be a protective factor against dental caries (OR 0.71), with duration having no significant effect. A lower prevalence of open bite (OR 0.67) and posterior crossbite (OR 0.68) was also observed. Breastfeeding for ≥ 6 months was protective against overjet, dental crowding, and Class II malocclusion. However, it was associated with an increased risk of overbite (OR 1.95). Narrative analysis showed benefits of breastfeeding for muscular and craniofacial development, and it was considered safe in children with post-surgical cleft lip/palate. Breastfeeding has positive effects on multiple aspects of children's oral health, reinforcing its importance for both oral and systemic health, thanks to its nutritional, mechanical and immunological benefits.

Background. Dental crowding is one of the most common dentofacial anomalies in children and adolescents, occurring in 35–65 % of school-age children. This pathology creates conditions for increased plaque formation in areas difficult to access for hygiene, increasing the risk of dental caries and inflammatory periodontal diseases. The relevance of this study is due to the need to develop effective strategies for oral hygiene care in children with dental crowding, taking into account age characteristics, severity of the anomaly, and level of manual skills development. Objective. To improve the level of oral hygiene in children aged 6–12 years with dental crowding by developing an algorithm for optimizing individual oral hygiene, taking into account the concentration of statherin protein in oral fluid as a marker of mineral metabolism. Materials and methods. A study was conducted of 60 children aged 6–12 years (32 boys and 28 girls), divided into two age groups: 6–8 years (n = 30) and 9–12 years (n = 30). Subgroups were identified in each group according to the degree of dental crowding (mild, moderate, severe). Green – Vermillion hygiene indices (OHI-S), bleeding index (PBI), and papillary-marginal-alveolar index (PMA) were determined. In 30 children, the concentration of statherin protein in oral fluid was determined by enzyme immunoassay (ELISA). The effectiveness of three types of tooth-brushes (manual with flat bristle field, manual with multi-level bristle field, electric) was evaluated after single brushing and after 1 and 3 months of use. Statistical processing was performed using Statistica 12.0. Results. The prevalence of dental crowding was 68.3% (41/60), with a tendency to increase with age (63.3 % in the 6–8 years group and 73.3 % in the 9–12 years group). A strong direct correlation was established between the degree of crowding and OHI-S values (r = 0.72, p &lt; 0.01). Mean PMA values significantly increased with increasing severity of crowding: 14.8 ± 2.3 % (no crowding), 23.5 ± 3.1 % (mild), 31.7 ± 3.8 % (moderate), 42.5 ± 4.7 % (severe) (p &lt; 0.05). Statherin concentration was significantly higher in children with crowding (3.2 ± 0.4 mmol/L in the 6-8 years group and 3.9 ± 0.5 mmol/L in the 9-12 years group) compared to children without pathology (2.7 ± 0.3 and 3.0 ± 0.3 mmol/L, respectively) (p &lt; 0.05). In children aged 6-8 years, manual brushes with multi-level bristle field and electric brushes showed comparable effectiveness (plaque reduction 68.4 ± 5.2 % and 70.8 ± 6.1 %), surpassing manual brushes with flat field (52.6 ± 4.7 %, p &lt; 0.05). In the 9–12 years group, electric brushes were most effective (75.3 ± 5.8 %), surpassing manual brushes with multi-level (64.2 ± 5.0 %, p &lt; 0.05) and flat (50.1 ± 4.5 %, p &lt; 0.01) fields. When using electric brushes for 3 months, a significant decrease in statherin concentration was noted (by 22.5 ± 3.8 % in the 6–8 years group and by 28.7 ± 4.2 % in the 9–12 years group, p &lt; 0.05). Conclusion. A correlation has been established between the degree of dental crowding and the level of oral hygiene. The concentration of statherin protein in oral fluid can serve as a risk marker and compensatory mechanism in dental crowding. A comprehensive algorithm for selecting oral hygiene products has been developed, taking into account age, degree of crowding, and level of manual skills.

In recent years, interest in esthetics has increased considerably, resulting in a growing demand for invisible orthodontic appliances, particularly among adolescents and adults. Bracketless orthodontic treatment is an advanced orthodontic approach that uses coated archwires and composite resin, applied with precision using three-dimensional technology. This method may offer an effective alternative to conventional bracket-based systems in certain cases. This single-case report described a clinical case of skeletal and dental Class I malocclusion characterized by moderate lower dental crowding (4.5 mm); midline shift; a dental crossbite involving teeth 14, 15, and 25; and an increased mandibular incisor inclination (lower incisor to mandibular plane = 104°). This condition was managed using the three-dimensional bracketless orthodontic treatment technique. This technique represents an advanced esthetic approach designed for individuals who prioritize dental appearance. It may reduce anterior teeth proclination by acting from the lingual side and may shorten treatment duration in cases of mild to moderate crowding, ensuring faster and more efficient outcomes.

Obesity and periodontal tissue diseases are recognized as global medico-social problems of modern so-ciety, characterized by a mutually potentiating effect. Their concurrence creates an unfavourable background for the development and progression of dentoalveolar abnormalities (DAA), which, in turn, exacerbate the course of periodontal diseases. The aim of the study was – to determine the prevalence and clinical features of dentoalveolar abnormalities in patients with periodontal tissue diseases against the background of obesity, and to establish the relationship between the severity of DAA, the degree of obesity, and the severity of periodontal pathology. Material and Methods. A comprehensive clinical examination was conducted in 467 patients aged 18-45 years diagnosed with periodontal disease in the presence of grade I-III obesity. Periodontal pathology was assessed according to the classification of M. F. Danilevsky, as modified by I. S. Mashchenko, while the degree of obesity was determined using the WHO classification. Examination of patients with dentoalveolar abnormalities was performed according to a unified protocol, which included analysis of postural status, assessment of the facial skeleton and soft tissues, intraoral evaluation of the dental arches and occlusion in three planes, as well as assessment of the condition of additional oral cavity structures. Results. The study established that the prevalence of dentoalveolar abnormalities in the cohort was – 82.87±1.74 %, whereas neutral occlusion was registered in only 17.13±1.74 % of cases, p&lt;0.01. The most common dentoalveolar abnormalities were distal occlusion of Subclass I – 34.05±2.19 % and Subclass II – 21.84±1.91 %, as well as dental crowding – 18.42±1.79 %. The highest objectively verified prevalence of Subclass I distal occlusion was 53.85±7.98 % in patients with generalized periodontitis II degree, p&lt;0.05. The maximum prevalence of dental crowding was observed among patients with grade III obesity – 60.0±1.20 %, which was 5.1 times higher than the corresponding indicator in grade I obesity, p&lt;0.01. Con-clusions. The study demonstrated that patients with periodontal tissue diseases in the context of obesity exhibit an extremely high prevalence of dentoalveolar abnormalities, exceeding 80 %. Distal occlusal forms and dental crowding were most frequently recorded, accompanied by pronounced occlusal disharmonies in different spatial planes. A distinct trend was identified toward increasing intensity and severity of dentoalveolar abnormalities with the progression of generalized periodontitis and higher degrees of obesity.

Pycnodysostosis is a rare autosomal recessive skeletal dysplasia resulting from pathogenic variants in the CTSK gene, which encodes cathepsin K, a lysosomal cysteine protease expressed in osteoclasts. Deficiency of this enzyme leads to defective bone resorption and generalized osteosclerosis. We report an 8-year-old girl, the firstborn of a third-degree consanguineous marriage, who presented with poor height and weight gain since birth and delayed developmental milestones, including independent walking at 2 years of age. Physical examination revealed proportionate short stature with microcephaly and brachycephaly. Craniofacial findings included frontal bossing, beaked nose, low-set posteriorly rotated ears, micrognathia and a high-arched fissured palate with dental crowding and supernumerary teeth. Thickened palmar skin, pectus carinatum, and saddle toe deformity were also seen. Fundoscopic examination demonstrated bilateral papilledema. Radiographic evaluation showed diffuse cranial sclerosis, wormian bones, hypoplastic clavicles, acro-osteolysis, and generalized increased bone density. Endocrine assessment revealed isolated low parathyroid hormone levels, an exceptionally rare association. Molecular genetic testing by clinical exome sequencing (CES) identified a homozygous pathogenic variant in exon 6 of the CTSK gene, establishing the diagnosis of pycnodysostosis. The patient was initiated on recombinant growth hormone therapy and referred for multidisciplinary follow-up, including endocrinology, dentistry, orthopedics, and ophthalmology. This case underscores both classical manifestations and unusual findings such as papilledema and low PTH levels. Early diagnosis through careful clinical evaluation and genetic confirmation enables timely initiation of appropriate interventions. Growth hormone therapy demonstrated consistent improvement in linear growth, emphasizing the potential for better long-term outcomes. A coordinated multidisciplinary approach remains essential to enhance prognosis and overall quality of life in children with this rare skeletal dysplasia.

Dentomaxillofacial deformities are highly prevalent oral diseases that exhibit pronounced temporal variation, and their occurrence and progression are closely associated with human evolution, lifestyle transitions, and genetic background. Archaeological research provides critical evidence for tracing the origin and evolutionary trajectory of dentomaxillofacial deformities. This review systematically summarizes archaeological findings of dentomaxillofacial deformities from prehistoric to historical periods, focusing on occlusal types, prevalence, and their spatiotemporal distribution patterns. By integrating morphological data from teeth and jawbones, the study further explores the relationships between malocclusion and dietary structure, economic modes, and population migration. The results indicate that dentomaxillofacial deformities were relatively rare in early human populations but increased markedly following the advent of agriculture and the refinement of food processing, particularly manifesting as higher frequencies of dental crowding and deep overbite, suggesting a pivotal role of environmental factors in their development. Meanwhile, variations in malocclusion patterns across different populations reflect the combined influence of genetic background and cultural factors. These archaeological findings reveal that dentomaxillofacial deformities demonstrate clear temporal variability and environmental dependence, and they provide a historical framework for understanding the high prevalence and etiological mechanisms of modern malocclusion, as well as a theoretical basis for optimizing orthodontic prevention and treatment strategies.

Supernumerary teeth (SPNs), as common odontogenic developmental anomalies, not only cause local complications such as dental crowding and impaction but also serve as key oral manifestations of multiple genetic syndromes. We report a case of multiple SPNs (7 teeth with an odontoma) in a 17-year-old Chinese male who presented without any genetic syndromes. Clinical examination revealed a permanent dentition exhibiting Angle Class II malocclusion with dental crowding, featuring an ectopically erupted tooth 34 positioned lingual to tooth 35, two supernumerary teeth in the lingual region of teeth 44-45, and partially erupted teeth 17 and 27. Comprehensive imaging revealed a compound odontoma palatal to teeth 24-25 and multiple supernumerary teeth in the mandibular arch, with no associated root resorption or genetic abnormalities. The final diagnosis was multiple Non-syndromic Supernumerary Teeth, for which staged surgical removal of the odontoma and impacted supernumeraries was planned. This case elucidates the core distinguishing features between Non-syndromic Supernumerary Teeth and Syndromic Supernumerary Teeth. Based on the clinical history, physical examination, imaging findings, and genetic testing, a final diagnosis of Non-syndromic Supernumerary Teeth was established for this patient. Building on this foundation, we established a four-step differential method comprising clinical screening, radiographic localization, genetic verification, and multidisciplinary coordination. This approach pioneers the proposal of tooth count as a primary indicator for syndromic risk, providing enhanced evidence-based guidance for early identification of genetic disorders.

The development of an image processing model to estimate tooth width and space requirements.

The impaction of the third molar is associated with specific facial skeletal and dental characteristics. Therefore, determining the type of facial skeletal growth may help predict third molar impaction and assist in treatment planning. This study aimed to investigate the correlation between the impaction of the maxillary and mandibular third molars with the vertical and anteroposterior dimensions of the face, as well as to examine the prevalence and type of impaction. In this descriptive-analytical study, panoramic and lateral cephalometric radiographs of 200 patients who were referred to a radiology center in Zanjan were examined. The position, angle, and type of impaction were evaluated on the panoramic radiographs, and the type of vertical and anteroposterior facial profile was determined through lateral cephalometry. Finally, the correlation between impaction and the type of facial profile was analyzed with the Chi-Square test at a significance level of 0.05. The prevalence of third molar impaction was higher in patients with skeletal Class II and those with a dolichofacial profile (55.5% and 63.5%). Class B, Class II, and mesioangular impactions were more common in the mandible, whereas Class C and distoangular impactions were more prevalent in the maxilla. The level of third molar impaction in the mandible was significantly related to the vertical dimension of the face (p= 0.003). The angle of impaction in the mandible was significantly associated with both the vertical and anteroposterior dimensions of the face (p= 0.036 and p= 0.014). The findings of this study can be beneficial in orthodontics for evaluating the impact of third molar impaction on dental crowding and facilitating the development of appropriate treatment plans. Knowing which individuals are more susceptible to third molar impaction enables specialists to implement early interventions. Additionally, timely referrals to oral and maxillofacial surgeons can be made when necessary.

Clear aligners are a popular alternative to fixed orthodontic appliances; however, technical data on the optimal final aligner shell thickness for directly printed aligners remain limited. This in vitro experimental pilot study evaluated the mechanical response of patient-specific, directly 3D-printed aligners of four nominal shell thicknesses (0.04, 0.06, 0.08, and 0.10 mm) fabricated from BioMed Clear resin. A single subject with dental crowding was scanned and a set of aligner shells was designed and printed (n = 3 per thickness). Compressive tests up to 1000 N were performed and compressive extension (mm) recorded; group means ± SD were compared by means of one-way ANOVA. No statistically significant differences in compressive extension were found among the four thickness groups (ANOVA, F(3,8) = 2.242, p = 0.161). The 0.08 mm group showed a lower mean compressive extension in this dataset, but the difference did not reach statistical significance; given the small sample size and single-subject nature of the study, this result should be considered exploratory. This recent study clarifies printing and post-processing parameters and highlights limitations and directions for future work.

It has been proven that comprehensive treatment with the additional use of the developed differentiated massage and myogymnastics improves the electromyographic parameters of the temporal, masseter, and orbicularis oris muscles. It has also been demonstrated that the application of the author’s theoretical and practical developments in orthodontic treatment of malocclusion complicated by dental crowding reduces the duration of treatment by an average of 1.45 times compared to conventional methods.

IntroductionMaxillary transverse deficiency (MTD) is a common craniofacial condition associated with posterior crossbite, dental crowding, and compromised respiratory function. This study aimed to evaluate whether the Invisalign Palatal Expander (IPE) can induce midpalatal suture opening and occlusal changes, and to compare these outcomes with those obtained using conventional rapid palatal expansion (RPE).Materials and methodsThirty subjects (14 females, 16 males; aged 6–18 years) with mixed dentition were enrolled and divided into two groups: 15 treated with IPE and 15 with RPE. Radiographic images and digital dental models were analyzed before (T0) and after treatment (T1) to assess skeletal and occlusal changes, including midpalatal suture opening and transverse arch dimensions. Molar tipping and palatal depth were also measured. Patient-reported side effects during the first month of treatment were evaluated using a questionnaire addressing bulkiness, tongue impression, dysphonia, dysphagia, and gag reflex, scored on a 1–5 scale. Inclusion criteria comprised mixed dentition, erupted first molars, deciduous fourth/fifth teeth or erupting premolars, and complete diagnostic records. Exclusion criteria included previous orthodontic treatment, craniofacial anomalies, extraction therapy, allergies, hereditary angioedema, or active caries.ResultsNo significant differences were found between groups in the number of activations, radiographic outcomes, or theoretical expansion, indicating comparable skeletal effects. Midpalatal suture opening was achieved in all patients. Baseline occlusal conditions were similar between groups. After normalization for the number of activations, statistically significant differences were observed for arch depth, canine gingival width, canine dental width, and arch perimeter, all of which were greater in the RPE group (p < 0.05). No significant differences were found in intermolar angle or palatal depth changes. Questionnaire analysis revealed no significant differences in reported side effects between groups.ConclusionsThe Invisalign Palatal Expander effectively produced transverse maxillary expansion with midpalatal suture opening, yielding skeletal and occlusal outcomes comparable to those of the Hyrax expander. Although the amount of expansion was slightly lower, the IPE demonstrated more controlled and predictable results, supporting its use as a valid alternative in mixed dentition and as a step toward fully digital orthodontic protocols.

Background: Hypocalcemic seizure is a well-known entity in infancy. However, late-onset hypocalcemic seizures are unusual and often point towards underlying endocrine or genetic disorders. Clinical Description: A 9-year-old girl presented with new-onset generalized tonic–clonic seizures. She had short stature, round facies, dental crowding, with the classical knuckle–knuckle–dimple–dimple sign. Father had a history of seizures with brain imaging showing basal ganglia calcification. Management and Outcome: Laboratory evaluation revealed hypocalcemia, hyperphosphatemia, and markedly elevated parathyroid hormone. Radiographs showed shortening of the 4 th and 5 th metacarpals, and neuroimaging revealed bilateral basal ganglia calcifications, consistent with pseudohypoparathyroidism associated with Albright hereditary osteodystrophy (AHO). The child was managed acutely with intravenous calcium and maintained on oral calcium and calcitriol supplementation. On follow-up, normalization of Vitamin D levels with persistently elevated parathyroid hormone confirmed end-organ resistance. She remains clinically stable on therapy with regular monitoring. Conclusion: This case highlights that hypocalcemic seizures in older children should prompt consideration of congenital and hereditary causes. Even in the absence of genetic testing, the constellation of classical phenotype, family history, and biochemical/radiological findings can establish the diagnosis of AHO. Timely recognition is essential for initiating therapy and counseling families about long-term follow-up.

Adult orthodontic treatment in patients with periodontal fragility requires careful interdisciplinary planning. This case report describes the interdisciplinary management of a 52-year-old female patient presenting with generalized gingival recessions (GRs), thin periodontal biotype, and dental crowding, treated using clear aligner therapy (CAT) combined with periodontal follow-up and postorthodontic mucogingival surgery. Orthodontic treatment was carefully planned to reposition dental roots within the alveolar housing while minimizing periodontal risk in the absence of CBCT. Following orthodontic alignment and retention, connective tissue grafting was performed to treat residual GRs. Clinical, radiographic, and occlusal outcomes demonstrated stable periodontal conditions, changes in occlusal contact distribution, and satisfactory esthetic results at 1-year follow-up. The uniqueness of this case lies in the use of clear aligners as a periodontal-supportive orthodontic strategy, combined with delayed surgical intervention, highlighting the role of precise root control and interdisciplinary coordination in periodontally fragile adult patients.

Oral diseases affect more than 3.5 billion people worldwide and remain among the most neglected global health challenges. Access to preventive oral healthcare is constrained by workforce shortages, transportation barriers, and patient apprehension toward dental procedures. Artificial intelligence (AI)-enabled diagnostic systems offer scalable solutions for early detection and triage through non-dental personnel. This study presents the Phase 1 analytical validation of Smilo.ai, an AI-driven platform designed for automated detection of common oral health conditions using standardized digital oral photographs. A cross-sectional validation study was conducted among 45 adult participants in a community-based oral health screening program in India between February 1 and 10, 2025. Each participant contributed one composite oral image containing four standardized views (frontal, left lateral, right lateral, and occlusal), yielding an analytical dataset of 45 images (n = 45). Smilo.ai's diagnostic outputs were compared with dentist evaluations of identical photographs across seven diagnostic categories: dental decay, gingivitis, plaque, calculus, tooth wear, discoloration, and crowding. Performance metrics included sensitivity, specificity, precision, accuracy, and Cohen's κ, computed using confusion matrix-based analysis in accordance with STARD 2015 and CONSORT-AI guidelines. Inter-rater reliability between the two reference dentists was retrospectively quantified, yielding substantial agreement (κ = 0.61). Smilo.ai demonstrated an overall sensitivity of 73.6%, precision of 46.0%, accuracy of 47.3%, and a macro-level Cohen's κ of 0.010 relative to dentist assessments. High sensitivity was achieved for dental decay, tooth wear, and discoloration (100% each); however, the corresponding near-zero specificity values indicate a pattern of positive prediction bias in the current model configuration. Calculus exhibited the strongest balanced performance (sensitivity 61.0%, specificity 65.0%, precision 73.9%, κ = 0.24). Gingivitis demonstrated moderate sensitivity (56.0%), while plaque and crowding showed partial detection with variable agreement. This Phase 1 validation establishes a performance baseline for Smilo.ai and identifies optimization priorities, including positive prediction bias correction and threshold recalibration necessary before screening workflow integration. AI-assisted screening models hold significant promise for improving preventive oral healthcare access among underserved populations. The upcoming Phase 2 validation will evaluate clinical generalizability through synchronous clinical examinations to confirm real-world applicability.

Abstract The pediatric population has malocclusions with a higher prevalence worldwide. Malocclusion in the mixed-dentition phase has a negative impact on the oral health-related quality of life of pediatric patients and their families. Discrepancy in the transverse dimensions of the maxillary arch may present a range of malocclusion conditions, including cross-bite, functional shift, crowding, impaction, and ectopic eruption of permanent teeth, etc. Usually, orthodontic intervention involves the maxillary expansion to correct the abovementioned malocclusion conditions. In growing children with mixed dentition, various orthodontic intervention modalities using removable or fixed appliances for addressing the maxillary/palatal constriction condition. However, literature highlights various drawbacks or limitations of these traditional appliances. In recent years, the use of clear aligners in pediatric patients in early orthodontic intervention for correcting various malocclusions, including dental crowding, anterior or posterior cross-bite, etc., has been described in the literature. Moreover, clear aligners have been highlighted recently in literature about its use for the purpose of maxillary expansion in the mixed-dentition stage of children. However, to date, there is no comprehensive review article in the existing literature describing the different clinical aspects and factors of the use of clear aligners for maxillary expansion in the mixed-dentition phase of growing patients. Hence, the intention of this review article was to extensively explore the relevant literature in online different databases and to summarize or highlight the clinically important findings and aspects reported by the pertinent published studies.