BackgroundIt is well known that certain bone diseases of congenital origin are associated with dentomaxillofacial (DOMF) disorders. The objective of this study was to evaluate and compare the DOMF alterations in pediatric patients with bone diseases in Arusha (Tanzania, East Africa) and Barcelona (Spain, southern Europe). In each area of study, the clinical differences between subgroups of bone diseases in relation to their etiopathogenesis were reported and analysed.Material & methodsA cross-sectional study of pediatric patients with bone diseases was carried out at two hospitals, Mount Meru Regional Referral Hospital (MMRRH), Arusha (n = 60) and Hospital Sant Joan de Déu (HSJD), Barcelona (n = 89), from 2019 to 2023. Mean age of the sample was 10.5 years (SD 4.05). In both groups the samples were recruited consecutively and were clinically evaluated for skeletal and DOMF disorders. The different bone pathologies were further divided into two subgroups according to their etiopathogenesis: (i) disorders in cellular metabolism (DCM); (ii) disorders of bone growth/deformity (DGD).ResultsGingival health indexes were significantly better in the HSJD group (p = 0.033). The HSJD group also had better caries indices (DMF-T), though these differences were not significant (p = 0.105). Among dental alterations, dental agenesis was significantly more prevalent in the MMRRH sample (p < 0.001); in this sample, DGD was significantly more frequent than DCM (p = 0.045). Fluorosis was practically non-existent in the HSJD group, but was moderate to severe fluorosis in 26.6% of MMRRH patients and was significantly more prevalent in the MMRRH DCM subgroup (p < 0.001). Malocclusion was more frequent in the MMRRH group (p < 0.001 in the case of Class III inverted overjet and p = 0.008 in the case of crossbite), and in the HSJD group the DCM subgroup presented a more severe overbite and open bite than the DGD subgroup (p = 0.027). Pathological fractures were significantly more frequent in the DGD subgroups in both samples (p < 0.001).ConclusionThere is a clear relationship between dentomaxillofacial abnormalities and rare bone diseases in the two pediatric populations studied. Comparing the two samples, the East African children displayed higher rates of gingivitis, dental fluorosis and malocclusion than their southern European peers.

Rationale:This case report aimed to describe a premolar preservation, nonsurgical approach for adult skeletal Class III open bite using third-molar extraction and buccal-shelf miniscrew-anchored mandibular arch distalization.Patient concerns:A 27-year-old female presenting with a 2 mm anterior open bite, bilateral Class III molar and canine relationships, mild bimaxillary crowding, and midline deviations underwent extraction of all third molars.Diagnoses:Skeletal Class III malocclusion secondary to excessive mandibular growth in a horizontal growth pattern, Class III dental relationships with marked proclination of the maxillary and mandibular incisors, anterior crossbite and open bite, and leftward mandibular deviation.Interventions:Fixed appliances were bonded to initiate leveling and alignment. Two buccal-shelf miniscrews provided anchorage for en-masse mandibular distalization with power chains and Class III elastics. Interproximal enamel reduction refined the incisal morphology of both the maxillary and mandibular incisors.Outcomes:After 19 months of active treatment, all objectives were achieved. Bilateral Class I canine and molar relationships were established, overjet normalized from –1.4 mm to +2.8 mm, and overbite from –1.8 mm to +0.9 mm. The upper lip remained essentially stable, whereas roughly 2 mm of lower-lip retrusion permitted the upper lip to overlap the lower. Both arches were well leveled and aligned, with coincident dental and facial midlines.Lessons:Selective third-molar extraction combined with buccal-shelf miniscrew-anchored mandibular distalization is an effective nonsurgical alternative for adult skeletal Class III open-bite cases, preserving healthy premolars and delivering stable occlusal and esthetic outcomes.

Relevance. Controlling the vertical size of the lower third of the face is one of the key tasks of modern facial-oriented orthodontics. It is of particular importance in the treatment of patients with open bite and vertical growth pattern. The purpose of this study was to quantify the intrusion of upper molars in patients with varying vertical parameters of facial growth and to analyze the influence of morphometric parameters on the effectiveness of treatment. Materials and methods. The study involved 55 patients (28 men and 27 women) aged 17-34 years who underwent orthodontic treatment for an open bite. Patients were divided into two groups: pre- and post-occlusal (n = 28) and meso-occlusal (n = 27), with indications for molar intrusion. The treatment methodology included intruding maxillary molars using microimplants, with a force of 200-250 g per side, controlled monthly. The results were analyzed after 6 months. CT imaging was performed before treatment and after 6 months on a Morita Veraview X800. 3D analysis was conducted in 3D Slicer 4.11, where CBCT scans were superimposed, and molar segmentation allowed measurement of vertical displacement. Data were analyzed in Jamovi 2.4 using paired and independent t-tests to evaluate changes. Statistical significance was set at p &lt;0,05. Results. The 3D analysis of intrusion revealed a statistically significant difference in the vertical movement of the first molars between patients with pre- and mesocephalic growth types. In the mesocephalic group, the average intrusion was: 1) palatal hump (P) - 2.00±0.24 mm; 2) mesial buccal hump (MB) - 1.78±0.32 mm; 3) distal buccal hump (DB) - 1.67±0.26 mm. In the pre- and mesocephalic group, the indicators were lower: 1) P - 1.31±0.28 mm; 2) MB - 1.11±0.29 mm; 3) DB - 0.98±0.31 mm. All differences were statistically significant (p &lt;0.001). Mesocephalic patients showed more pronounced intrusion, and asymmetry of intrusion was observed, which may indicate a tilt of the molar crown. These data confirm the influence of facial morphotype on the effectiveness of molar intrusion and may help predict the outcomes of orthodontic treatment in open bite. Conclusion. The mesocephalic vertical type of facial growth offers greater efficiency in molar intrusion compared to the pre-lychiocephalic type. The maximum vertical displacement occurs in the area of the palatine tubercle, highlighting the importance of an individualized approach when planning treatment. The use of CBCT superimposition with voxel-based registration ensures precise measurements, and combining support patterns can enhance intrusion outcomes in patients with less favorable patterns. Future studies may explore the effects of support types and bone morphometric characteristics on the clinical success of intrusion.

Imaging of Benign and Malignant Temporomandibular Joint Tumors.

A diagnostic and treatment planning checklist for vertical problems in orthodontic patients.

This research aims to analyze the impact of prolonged pacifier use on the orofacial development of children aged 0 to 6 years. The content addresses the causes and consequences of this habit. The scientific literature indicates that pacifier use, especially after the age of 2 or 3, can interfere with the natural growth of the maxilla and mandible. This interference is directly related to the development of malocclusions, such as anterior open bite, posterior crossbite, and palatal atresia. Furthermore, the topic explores the consequences on orofacial musculature and its implications for speech, swallowing, and breathing functions.The methodology applied in research on this topic is generally descriptive and exploratory. Studies commonly use systematic literature reviews or observational and cross-sectional research to collect and analyze data both qualitatively and quantitatively. The deductive method is widely used to interpret results, starting from consolidated theories about child development and the physiology of the stomatognathic system. The results obtained from studies on the topic consistently demonstrate a strong association between prolonged pacifier use and the development of orofacial alterations. The main conclusion is that the early interruption of this habit is fundamental for a child’s healthy growth and development. The evidence reinforces the importance of professional action, such as that of a dental surgeon, in guiding parents and promoting breastfeeding as a protective and preventive factor.

Background: Orthognathic surgery aims to align the jaws with the facial skeleton and correct dental occlusion. This paper introduces the concept of planning the maxillomandibular complex (MMC) as a whole, utilizing a t-forming set of landmarks: the maxillary central incisor, the chin, and the occlusal plane. Methods: The background, hypothesis, and rationale of the new T concept are explained. A case of a 28-year-old male with skeletal class III malocclusion and an open bite was used to illustrate the application of the T concept in step-by-step surgical planning. The planning encompasses four phases: Phase One involves correcting frontal deformity and various asymmetries, Phase Two involves correcting chin anterior–posterior deformity, Phase Three involves correcting anterior–posterior and vertical MMC position, and Phase Four involves correcting MMC rotation. Results: The T concept provided a structured approach to plan MMC as a whole and integrate all structures into harmony. Conclusions: The T concept provides a logical approach to MMC positioning in orthognathic surgery, addressing functional and aesthetic concerns. It acts as a checkpoint to verify MMC position, helping surgeons achieve better results and avoid compensatory procedures.

This study aims to assess the clinical outcomes of anterior teeth intrusion overcorrection using clear aligners in deepbite patients and to investigate potential factors associated with the clinically achieved overcorrection amount. Twenty-four patients with deepbite (13-50 years, mean age 26.3 years; 17 females, 7 males) treated with Invisalign incorporating overtreatment were retrospectively reviewed. Pre- and post-treatment intraoral scans were superimposed using anatomical landmarks and aligned with ClinCheck models. Overbite reduction, and the differences between the simulated and achieved movements of individual anterior teeth were measured. Linear regression analyses were performed to identify variables potentially influencing intrusion outcomes. The mean overbite reduction was 3.3mm, and the overall accuracy of intrusion was 52.2%. Maxillary and mandibular incisors achieved 0.7-1.8mm of intrusion (47.3%-55.0%), whereas the canines showed lower intrusion (0.2-0.5mm, 23.1%-29.0%). Regression analysis suggested initial overbite, mandibular plane angle, upper incisor inclination, ANB angle and the use of Class II elastics as variables that may be associated with achieved intrusion. A strategically designed occlusal setup-characterized by a fusiform anterior open bite, deepened maxillary occlusal curve, and reverse curve of Spee in the mandible-may facilitate effective deep bite correction with clear aligners. This study presents a potentially effective and minimally invasive protocol for deepbite correction with clear aligners, drawing biomechanical inspiration from the reverse curve of Spee, commonly used in fixed orthodontics. Patient-specific anatomical and treatment-related factors appear to influence outcomes and should be taken into account in treatment planning.

Patients with bilateral mandibular resorption and malunion after bilateral sagittal split osteotomy (BSSO) presented with an anterior open bite, chin retrusion, and facial deformity, necessitating a second orthognathic surgery and jaw reconstruction. Due to the rarity and unclear etiology of this complication, careful selection of repair techniques is imperative for managing such discontinuous mandibular defects. Patient demands, such as concealed surgical incisions, fewer operations, high success rates, and accurate outcomes, should be considered, specifically in young females. Following virtual surgery for occlusion correction, as well as condyle and mandibular ramus repositioning, the extent of bilateral defects can be assessed. After weighing all reconstructive options, two separate vascularized fibula free flaps, prepared from a single fibular donor site, were selected for bilateral reconstruction. To effectively address intraoperative changes and enhance contact area between the fibular segments and mandibular rami, a sliding design, modified step-cut osteotomy, and length-gradient titanium plates were adopted. With the aid of 3D-printed osteotomy guides and titanium plates, the surgical procedure was successfully performed according to the predetermined design through bilateral Risdon incisions. Favorable postoperative healing, a stable occlusal relationship, a well-formed mandible, and improved facial aesthetics were successfully achieved at a two-year follow-up.

The aim of this cross-sectional epidemiological study was to explore the associations of age and occlusal factors with the severity of malocclusion among preschool children attending public kindergarten in Tirana, the capital city of Albania. Clinical data regarding malocclusion traits were collected from October 2023-May 2024 by examining 3- to 6-year-old children who were frequenting 18 randomly selected public kindergartens in Tirana, Albania. A child presenting one of the following altered occlusal traits was recorded as having malocclusion: class II or III canine relationship, distal step (Ds), increased overjet (OVJ), deep overbite (OVB) > 50% or anterior open bite (AOB), cross bite (CB) either anterior (ACB) or posterior (PCB). The relationships between categorical variables were evaluated with the continuity correction test, Fisher's exact test for 2 × 2 tables and the Pearson chi-square test forr×c tables. Binary logistic regression analysis and multivariable logistic regression analysis were used to determine the risk factors affecting a child's malocclusion severity. A total of 719 children aged 3-6 years (362 females and 357 males) with a mean age of 4.03 years who met the inclusion criteria were included in the study. There were no differences in terms of age or sex. The OVJ frequency and incidence of deep OVB > 50% were 15.4%, and deep OVB was more common in the 4-year-old group. The incidence of AOB was 2.6%, which was greater among 5-year-old children. The multivariate regression analysis revealed that children in the 4-year-old group had a 1.62-fold greater risk of developing severe malocclusion (OR (95% CI):1.62 (1.05-2.50); p = 0.030). Those with increased OVJ had a 15.15-fold greater risk of developing more severe malocclusion (OR (95% CI):15.15 (5.87-39.09) p < 0.001). The results of this study demonstrate that an age of 4 years, increased OVJ, a class III canine relationship and primary second molars in Ds are factors associated with the severity of malocclusion among preschool children.

Background: Peripherally induced movement disorders are hyperkinetic conditions triggered by peripheral trauma or surgical intervention. Oromandibular dystonia (OMD), a focal dystonia affecting the masticatory and lingual muscles, is the most common peripherally induced movement disorder within the stomatognathic system. However, OMD following orthognathic surgery has rarely been reported.Objective: This study aimed to describe the clinical characteristics, latency, and treatment outcomes of patients who developed OMD after orthognathic surgery in a retrospective single-center case series of six patients.Methods: This retrospective case series included patients presenting with involuntary orofacial movements after orthognathic surgery at Kyoto Medical Center between 2007 and 2025. Inclusion criteria were as follows: onset of OMD within three months following surgery, anatomical correlation, and patient-reported causality. Clinical features, surgical history, latency, and treatment outcomes were analyzed.Results: Six patients (mean age 35.2 years) met the criteria. Four had mandibular prognathism, one had mandibular prognathism with tongue hypertrophy, and one had bimaxillary prognathism with open bite. All underwent sagittal split ramus osteotomy: two had additional Le Fort I osteotomy, one underwent intraoral vertical ramus osteotomy, and one had tongue reduction surgery. OMD subtypes included jaw closing (n = 2), tongue (n = 2), jaw opening (n = 1), and jaw deviation (n = 1). Mean latency to OMD onset was 39.5 days, while the mean delay before referral was 40.3 months. All patients were treated with botulinum toxin injections, resulting in symptomatic improvement. Notably, none of the surgeons initially recognized the association with surgery.Conclusions: OMD may occur as a possible peripherally induced sequela of orthognathic surgery. Although rare, it is likely underdiagnosed. Oral and maxillofacial surgeons should remain aware of this potential complication to facilitate timely diagnosis and appropriate management.

Nonsurgical Treatment Of Open Bite With Periodontally Accelerated Osteogenic Orthodontics

A Case Of Open Bite Treated With Extraction Orthodontics

Introduction: Traumatic dental injuries (TDIs) involving permanent anterior teeth are a prevalent type of dental injury in school-going children and can have a considerable impact on their physical health, psychological well-being, and social functioning. In the state of Goa, a study on TDI prevalence and its associated risk factors among children aged eight to 12 years has not been conducted.Aim: This study aimed to determine the prevalence of TDIs and its association with various risk factors in eight- to 12-year-old children in the state of Goa.Materials and methods: A cross‑sectional study was conducted on 2,732 school‑going children aged eight to 12 years. A detailed history and examination of 202 children who were identified with dental trauma was performed. Anterior dental trauma was assessed, and the data obtained were statistically analyzed.Results: A prevalence of 202 out of 2,732 (7.39%) children was observed in the sample studied. TDIs in rural areas comprised 132 (65.34%) children. Single-tooth enamel fractures were most commonly seen. Left maxillary central incisors were mostly involved. About 80 (39.60%) subjects were unaware of their TDI incident. About 91 (45%) subjects had overjet <3 mm, three (1.5%) children showed anterior open bite, 168 (83.2%) children had Angle’s class I molar relation, and 194 (96%) children presented with competent lips. Among the subjects with trauma, only 25 (12.4 %) children sought treatment, while the remainder, 151 (74.8%) children, were unaware that they should seek treatment. Moreover, most of the children were unaware of the immediate management and first aid for TDI episodes.Conclusion: This study provides valuable insights into the prevalence of TDIs among children in Goa, emphasizing the higher occurrence in rural areas, maxillary central incisors, and enamel fractures. Moreover, the study has found that only 25 (12.4%) children sought treatment for dental trauma, indicating the need for increased awareness and elaboration of prevention strategies for TDIs at the population level.

Intermediate butterfly osteotomy with rigid external distraction in Crouzon syndromes

Multidisciplinary management and long-term follow-up of macroglossia-associated anterior open bite in a patient with Beckwith-Wiedemann syndrome

Anterior open bite treatment with clear aligners in adults

Mechanisms of primary failure of eruption: a new model of multidimensional framework.

BackgroundMalocclusion affects oral health and aesthetics, traditionally classified using systems like Angle’s, which depend on physical exams or casts. Digital dentistry has shifted towards intraoral photography for documentation and assessment, though interpretation requires clinical expertise. The application of artificial intelligence (AI), and specifically deep learning, in medical imaging has been successful but remains largely unexplored in occlusal classification from intraoral photos. This study introduces a deep learning model to automate the classification of occlusal types from intraoral photographs, aiming to improve efficiency and objectivity in orthodontic diagnosis and treatment planning.ObjectivesOcclusal classification is a crucial prerequisite for designing orthodontic treatment plans. Therefore, this study aims to develop an evaluation tool utilising a deep learning approach to automatically identify occlusal types reflected in digital oral photographs.MethodsUsing a large-scale dataset with high-quality annotations (comprising 5,000 orthodontic intraoral photographs at a 45° lateral view and 2,200 at a 90° lateral view from 6,100 patients), three deep-learning models were developed based on Swin Transformer for the identification of various occlusal classifications: Molar occlusal relationships (M1, M2, M3), canine occlusal relationships (C1, C2, C3), and anterior overbite relationships (normal overbite, deep overbite, edge-to-edge bite, open bite, anterior crossbite, single-tooth crossbite or segmental crossbite).ResultsOur model achieved weighted average F1-scores of 0.90 and 0.87 for molar and canine occlusal relationships, respectively. Regarding anterior overbite relationships, the model attained a weighted average f1-score of 0.89, with subclass F1-score ranging from 0.86 for edge-to-edge bite to 0.94 for deep overbite.ConclusionsOur deep learning model has successfully achieved the primary objectives of identifying molar and canine occlusal relationships, as well as anterior overbite relationships, using intraoral digital photographs. The demonstrated performance of this model highlights its potential for clinical applications.Clinical significanceThe application of deep learning models for occlusal classification depicted in digital intraoral photographs, which enables clinicians to extract key information rapidly, holds significant implications for patient management and treatment monitoring in orthodontic practices.

Background/Objectives: Anterior open bite is a multifact orial malocclusion influenced by genetic and environmental factors. Variants in the Collagen type I, alpha 1 (COL1A1) gene, particularly rs1800012, have been implicated in bone quality, but their role in craniofacial anomalies remains unclear. Methods: A case–control study was conducted with 60 participants (30 anterior open bite cases; 30 matched controls). DNA was extracted from buccal swabs, and rs1800012 genotyping was performed using TaqMan assays. Genotype and allele distributions were compared with chi-square and Fisher’s exact tests; Hardy–Weinberg equilibrium was assessed in controls. Results: Genotype (GG/GT/TT: 53.3/40.0/6.7% vs. 60.0/33.3/6.7%) and allele (T allele: 26.7% vs. 23.3%) frequencies did not differ significantly between cases and controls. No association was detected under additive, dominant, or recessive models (all p > 0.05). Wide confidence intervals indicated limited precision of effect estimates. Conclusions: This study provides no evidence of association between COL1A1 rs1800012 and anterior open bite in this Turkish cohort. The relatively small sample size, the rarity of the TT genotype, and the multifactorial nature of craniofacial development represent important limitations. Larger, multi-gene, and functionally integrated studies are required to clarify the genetic architecture of open bite malocclusion.