Successful orthognathic therapies are characterised by aphysiologically configured occlusion whose long-term clinical stability is mainly assessed through occlusal parameters. In the present study, long-term treatment outcomes were assessed based on occlusal changes after 5years using digital occlusion and masticatory efficiency analysis. This study examined 33adult patients after treatment of skeletal classII (n = 18; 12women, median age 28.15 years; interquartile range [IQR] = 15.10) and classIII malformations (n = 15; 7women, median age 23.90 years; IQR = 4.80) 9months (T1) and 5years (T2) postorthognathic therapy. A total of 20patients with neutral skeletal relation (10women; median age 30.50 years; IQR = 7.50) served as acontrol group. Skeletal classification was based on sagittal jaw configuration (Wits) and habitual intercuspation was recorded using the T‑Scan Novus® (Tekscan Inc., South Boston, MA, USA) for digital occlusion analysis with the following variables: total tooth contact (TTC), occlusion time (TOC), occlusion asymmetry (OAS), anterior and posterior antagonism (ATC and PTC). In addition, masticatory performance was assessed using astandardized two-colour chewing gum bolus analysis. Five years after surgery (T2), none of the occlusal parameters differed significantly between the groups, indicating functional approximation to the control group. Longitudinal analysis revealed significant improvements within both surgical groups (T1 to T2). In classII patients, TTC, ATC and PTC increased, while TOC decreased significantly. ClassIII patients also showed significant increases in TTC, ATC and PTC with TOC and OAS remaining unchanged. Overall, both treatment groups demonstrated substantial recovery and long-term stabilization of occlusal function. Bolus homogeneity analysis showed no significant difference between control and treatment patients 5years after surgery. The 5‑year observation of orthognathic treatment for sagittal jaw malformations showed significant improvements in occlusal parameters. Both masticatory efficiency and occlusal parameters measured at 5years postoperatively did not differ significantly from the control group, indicating that the functional improvements achieved by the therapy were stable in the long term.

This study aimed to evaluate changes in horizontal condylar angulation (HCA), joint space distances (JS), condylar volume (CV), and degenerative alterations of the temporomandibular joint (TMJ) using preoperative and postoperative cone-beam computed tomography (CBCT) images of Class II and Class III malocclusion patients undergoing orthognathic surgery. This retrospective study included 148 CBCT images obtained from 74 patients who underwent bimaxillary surgery involving Le Fort I osteotomy and bilateral sagittal split ramus osteotomy. Patients were classified into Class II and Class III groups according to ANB angles. The patients' JS, HCA, and CV were measured, and degenerative changes observed in the condyle were recorded. Statistical analyses were performed using TURCOSA statistical cloud software. CV in Class II patients was significantly lower and HCA of Class II patients was higher in both periods (CV: p<0.001/p<0.001; HCA: p<0.001/p<0.05). HCA of Class III patients increased in the postoperative period (p<0.001). In preoperative period, superior and posterior JS distances were significantly higher in Class II patients (p<0.05/p<0.05). All patients had a negative and significant correlation between HCA and CV (p<0.05). In the postoperative period, sclerosis, osteophyte formation, and condylar resorption were observed significantly more frequently in Class II patients (p<0.05/p<0.001/p=0.021). Different adaptive responses occur in the TMJ of Class II and Class III patients following orthognathic surgery. In Class II patients, postoperative reductions in SJS, PJS, and CV values, together with a higher incidence of degenerative changes, such as sclerosis, osteophyte formation, and condylar resorption, indicate an increased risk for TMJ health in this group. In contrast, the postoperative increase in HCA observed in Class III patients may be considered an adaptive alteration. Therefore, careful monitoring of TMJ health and the implementation of long-term follow-up strategies are clinically essential, particularly in Class II patients.

Management of skeletal Class II malocclusion remains a persistent orthodontic challenge, particularly in selecting an effective alternative to fixed functional appliances. Therefore, it is of interest to evaluate the clinical and cephalometric effects of Class II elastics in 10 patients with skeletal Class II malocclusion. Pre- and post-treatment cephalometric parameters, including SNA, SNB, ANB and overjet, were compared using paired t-test analysis. Data shows significant improvement in cephalometric angles and overjet reduction, with dentoalveolar changes being more pronounced than skeletal changes. Thus, we show Class II elastics as a clinically effective alternative in borderline skeletal Class II cases, with outcomes comparable to fixed functional therapy in selected patients.

To compare the effects of functional orthopedic treatment and mandibular advancement induced by orthognathic surgery on hyoid bone position in individuals with skeletal Class II malocclusion, relative to an untreated control group. Fifty-six individuals were divided into functional (n=20), surgical (n=16), and control groups (n=20). Lateral cephalometric images obtained at pretreatment (T0) and posttreatment (T1) were analyzed using WebCeph software. The linear (aC2-H, aC3-H, aC4-H, S-H, N-H, ANS-PNS- H) and angular (SNA, SNB, ANB, Go-H-S, H-S-N, H-PNS-ANS) describing hyoid bone position were measured. Data normality was assessed with the Shapiro-Wilk test, followed by one-way ANOVA or Kruskal-Wallis test, as appropriate. Intragroup changes were evaluated using paired tests, and post-hoc analyses were performed using Tukey honestly significant difference or Dunn-Bonferroni methods. Measurement reliability was confirmed (intraclass correlation coefficients >0.90). At T0, the orthognathic surgery group showed significantly higher aC2-H, aC3-H, aC4-H, S-H, N-H, and ANS-PNS-H measurements compared to the other groups (p<0.05), while angular variables did not differ significantly. At T1, intergroup differences in hyoid position were no longer significant (p>0.05). Intragroup analysis revealed significant increases in aC2-H, aC4-H, S-H, and N-H in the functional treatment group, whereas significant decreases in N-H, H-S-N, and H-PNS-ANS were observed in the orthognathic surgery group. Changes in the control group were minimal. Functional treatment resulted in anterior-inferior displacement of the hyoid bone, whereas orthognathic surgery predominantly induced superior displacement without significant anteroposterior change. Both treatment modalities improved mandibular skeletal relationships, while hyoid position remained largely stable in untreated individuals.

ObjectiveTo evaluate 3-dimensional pharyngeal airway changes following 2-jaw orthognathic surgery in skeletal Class III patients and to assess their association with surgical movements.DesignRetrospective observational study.SettingSingle tertiary care center.PatientsTwenty-seven adult patients with skeletal Class III malocclusion who underwent Le Fort I maxillary advancement combined with bilateral sagittal split osteotomy mandibular setback.InterventionsAll patients received 2-jaw orthognathic surgery with preoperative (T0) and postoperative (T1, 6 months) computed tomography imaging.Main Outcome MeasuresThree-dimensional airway volumes of the nasopharynx, oropharynx, and hypopharynx were measured. Correlations between airway volume changes and skeletal movements were analyzed.ResultsSignificant regional differences in airway changes were observed. The nasopharyngeal airway volume increased (+1979.1 mm3), while the oropharyngeal airway showed minimal change (+336.4 mm3). In contrast, the hypopharyngeal airway demonstrated a significant reduction (-1087.5 mm3). A strong correlation was found between mandibular setback and hypopharyngeal airway reduction at Point B (r = 0.73, P = .023).ConclusionsTwo-jaw orthognathic surgery results in region-specific airway changes. Hypopharyngeal airway reduction is associated with mandibular setback, while maxillary advancement contributes to upper airway enlargement. These findings reflect morphological rather than functional changes, and further studies incorporating functional assessments are required to determine their clinical significance.

BackgroundThis study aimed to develop an integrated artificial intelligence (AI) pipeline for cervical vertebral maturation (CVM) staging and skeletal jaw relationships and to validate its output against the results of human observers.MethodsA total of 720 lateral cephalograms were collected from the archives of the orthodontic department. The participants’ ages ranged from 8 to 18 years. Cephalograms were categorized into six cervical stages based on McNamara’s criteria and classified into skeletal Class I, II, and III patterns based on their ANB angles. The dataset was divided into a training set (n = 540) and a test set (n = 180). The training set was used to train a convolutional neural network (CNN) and a YOLOv8 model. The test set of cephalograms was coded and randomly assigned to two orthodontists for comparison with the AI model results using weighted kappa and Cohen’s kappa statistical analyses to verify accuracy.ResultsFor human observers, the interobserver agreement ranges were as follows: (κw ≈ 0.976–0.989) for skeletal classification and (κw ≈ 0.956–0.999) for CVM staging, while the intra-observer reliability was also almost perfect for both methods (κw ≈ 0.82– 0.85). Substantial agreement was found between the generated AI model and human observers for skeletal classification (κ = 0.725) and CVM staging (κ = 0.786). Both results were statistically significant (p < 0.01).ConclusionsWithin the limitations of this study, the AI model exhibited substantial agreement with human observers for CVM staging and skeletal assessment, demonstrating its potential viability as a clinical decision-support tool.

This study aimed to develop and validate a data-driven framework using a radial basis function (RBF) neural network to predict site-specific alveolar bone remodeling during mandibular incisor decompensation in patients with skeletal Class III malocclusion. This retrospective cohort study included 10 patients (39 mandibular incisors). Pre- and post-treatment cone-beam computed tomography scans were registered in three dimensions. A novel geometric framework quantified tooth movement using four parameters: rotation radius, chord length, rotation angle, and vertical displacement. An RBF neural network was trained to model the nonlinear relationship among pre-orthodontic morphology, tooth movement patterns, and post-treatment alveolar bone thickness. Model performance was evaluated using the mean squared error and coefficient of determination (R2). Distinct alveolar bone response patterns were identified. Compression-side resorption approached a biological limit near 0mm. Tension-side apposition exhibited spatially graded efficiency, increasing from approximately 0% at the cervical level to 50-60% at the apical level. The RBF-based predictive model achieved high accuracy (R2 = 0.7-0.9) and effectively captured the nonlinear interplay between movement types and local anatomical constraints. The established framework accurately quantifies and predicts site-specific alveolar bone responses. Bone remodeling is governed by the synergistic interaction between tooth movement patterns and intrinsic anatomical limitations. This framework enables preemptive risk assessment and supports personalized orthodontic treatment planning.

Tongue function significantly influences craniofacial development, yet the morpho-functional characteristics of the tongue across different sagittal skeletal patterns remain unclear. This study aimed to quantitatively evaluate tongue muscle strength and resting posture in adolescents, delineate their biomechanical pathways, and construct data-driven diagnostic models for sagittal skeletal patterns. A cross-sectional study was conducted on 182 adolescents (11-17 years) stratified into Class I, II, and III sagittal patterns based on the ANB angle. Maximum active tongue pressure (MTP) was measured using a digital dynamometer. Resting posture, including the Tongue Tip Index (TTI), Tongue Tip Distance (TTD), and Tongue Dorsum Distance (TDD), was evaluated using lateral cephalograms. Data were analyzed using multivariable linear regression analysis, mediation analysis, and a Chi-squared Automatic Interaction Detection (CHAID) algorithm. The Class III cohort exhibited significantly reduced MTP (median: 1.65kg) compared to Class I and II subjects (~ 2.20kg; P < 0.001). Mediation analysis identified a partial mediation relationship: while MTP demonstrated a significant direct statistical association with the ANB angle, 32.4% of the total association was indirectly mediated through TTI. The CHAID model identified reduced MTP (≤ 1.85kg) as the primary root node associated with Class III risk. TTI (≤ 2.57%) served as a critical secondary stratifier of Class III risk. In adolescents, skeletal Class III malocclusion is associated with reduced tongue pressure and a lowered resting posture. Tongue muscle force demonstrates both a direct statistical association with the sagittal skeletal base and an indirect association mediated by the maintenance of an appropriate tongue tip position. The diagnostic model highlights reduced MTP as the primary risk indicator for Class III patterns, which is further stratified by TTI.

This controlled retrospective study aimed to evaluate the effects of maxillary protraction therapy on mandibular symphysis morphology. In this regard, 35 growing individuals with skeletal class III malocclusion due to maxillary retrognathia were assigned to two groups. The experimental group (n = 20) was treated with a Petit-type face mask (FM), while the control group (n = 15) had similar characteristics and were untreated. Linear and angular measurements related to the mandibular symphysis were evaluated on lateral cephalometric radiographs obtained before treatment (T0) and after treatment (T1). Kolmogorov-Smirnov tests, paired T-tests, and independent-samples T-tests were used for statistical analyses. In the FM group, there were significant increases in the lingual height (p = 0.021), B-Pogonion (p = 0.016), and Infradentale-Menton (Id-Me; p = 0.003) parameters following treatment, whereas a significant decrease was found in the incisor mandibular plane angle (IMPA) angle (p = 0.001). In the control group, there were no significant changes in either linear or angular measurements (p > 0.05). Intergroup comparison of treatment and observation-related changes revealed significant differences in the IMPA (p = 0.023) and Id-Me measurements (p = 0.048). The absence of significant differences in parameters other than the Id-Me-which could be related to the retrusive effect of the face mask on the lower incisors-suggests that face mask treatment does not have a significant short-term effect on mandibular symphysis morphology.

Morphometric assessment of the mandibular retromolar space for orthodontic molar distalization: A systematic review of CT and CBCT evidence.

The aim of this study was to evaluate and compare the skeletal, dental, and soft-tissue effects of the Twin Block, Monoblock, and Invisalign Mandibular Advancement (Invisalign MA) appliances used for functional treatment in individuals with skeletal Class II malocclusion. The study included 45 individuals in the S-MP3cap stage of growth and development who were treated with Monoblock (n = 15), Twin Block (n = 15), or Invisalign MA (n = 15) appliances. Lateral cephalometric radiographs were obtained before functional treatment (T0) and after treatment (T1). A total of 29 measurements were used to assess changes in the dental, skeletal, and soft tissues. Across all treatment groups, significant decreases were observed in ANB°, Wits appraisal, overjet, overbite, and skeletal and soft-tissue convexity angles; similarly, significant increases were identified in SNB°, Co-Gn (mm), Pg-Na Perp, FMA°, GoGn-SN°, LFH/TFH, L1-NB°, IMPA°, and the nasolabial angle throughout the treatment period. No statistically significant differences were found among the groups regarding the changes observed in the soft tissues. The Invisalign MA group showed less increase in vertical parameters than the other groups. Maxillary incisor inclinations decreased more significantly in the Invisalign MA group. Mandibular incisor inclination changes were similar between Monoblock and Invisalign MA groups but greater in the Twin Block group. Maxillary molar eruption was comparable between Invisalign MA and Monoblock groups, while Twin Block showed a more pronounced increase. Finally, mandibular advancement angles were similar across all groups.

Artificial intelligence has increasingly been applied to orthodontic diagnosis and treatment planning. Clinical decision-making in orthodontics is complex and often varies among practitioners, particularly for decisions such as tooth extraction, skeletal classification, and selection of treatment modality. This systematic review aimed to evaluate how artificial intelligence and knowledge-based systems have been developed and assessed for orthodontic treatment planning, to compare their performance with expert clinicians, and to examine how different learning approaches influence accuracy, interpretability, and potential clinical integration. A comprehensive search of PubMed, Embase, Scopus, Web of Science, Cochrane Library, and IEEE Xplore was conducted from database inception to 15 October 2025 without language or date restrictions. Eligible studies evaluated artificial intelligence-based or knowledge-based systems using real orthodontic patient data to support diagnosis or treatment planning. Two reviewers independently screened records, extracted data, and assessed risk of bias using the ROBINS-I tool. Due to heterogeneity in study designs, decision tasks, and outcome measures, findings were synthesized narratively rather than through meta-analysis. Nineteen studies met inclusion criteria. Most investigated supervised machine-learning models for extraction decisions, skeletal classification, or multi-step treatment planning, while others evaluated rule-based, fuzzy, Bayesian, or hybrid systems. Reported accuracies frequently exceeded 80%, and in some studies surpassed 90% when compared with expert decisions. Knowledge-based systems, including rule-based, fuzzy, and Bayesian/probabilistic approaches, offered greater transparency in reasoning, whereas data-driven models often demonstrated higher discriminative performance. Overall risk of bias was predominantly moderate to serious, largely due to retrospective designs, single-center samples, limited external validation, and reliance on expert opinion as the reference standard. Artificial intelligence systems can approximate expert orthodontic decision-making for defined diagnostic and planning tasks and show promise as clinical decision-support tools. However, current evidence is limited by methodological weaknesses and lack of prospective validation. These systems should presently be considered adjunctive aids rather than autonomous planners. Robust multicenter studies with external validation are needed before routine clinical implementation can be recommended. PROSPERO 1025581. Registered prospectively.

Histogram analysis of coronal magnetic resonance imaging of condyle in female patients with jaw deformity.

Skeletal changes between the surgical-first and conventional orthognathic approaches in skeletal Class III patients after excluding occlusal interference effects: Systematic review and meta-analysis.

While malocclusion prevalence and orthodontic treatment need have been widely described, the association between objectively quantified craniofacial morphology and actual orthodontic treatment initiation remains insufficiently characterised. This study aimed to identify cephalometric parameters associated with orthodontic treatment initiation in routine clinical practice. A retrospective observational study was conducted using clinical records from a private orthodontic centre in Poland. Consecutive patients aged ≥ 11 years who attended an initial orthodontic consultation between 2022 and 2024 and had a lateral cephalogram were included (n = 902). Orthodontic treatment initiation at the study centre was defined as a binary outcome (yes/no). Cephalometric variables derived from Segner-Hasund analysis were assessed, including sagittal and vertical skeletal parameters, dentoalveolar measurements, and soft-tissue indices. Comparisons between treated and untreated individuals were performed using non-parametric tests, with additional analyses stratified by gender and age. Also, the univariate and multivariable logistic regression modelling was conducted. Of the 902 participants, 490 initiated orthodontic treatment and 412 did not. No significant differences were observed for sagittal skeletal parameters (SNA, SNB, ANB, Wits appraisal) or skeletal class distribution between groups. In contrast, significant differences were identified for vertical skeletal configuration (NSL-NL), maxillary incisor protrusion relative to NA (1+:NA, mm), and the lower facial height index. Gender-stratified analysis revealed that treatment initiation in females was associated primarily with maxillary incisor inclination and protrusion, whereas in males it was associated with vertical skeletal parameters and lower facial height. Age-stratified analyses indicated that vertical skeletal characteristics were more strongly associated with treatment initiation in adult and older individuals, while no clear cephalometric differentiators were identified in younger patients. In logistic regression analysis, increased NSL-NL angle was independently associated with a lower likelihood of undertaking orthodontic treatment, while greater upper incisor protrusion (1+:NA, mm) increased the probability of treatment initiation. Although several associations reached statistical significance, the majority of cephalometric variables showed no significant relationship with treatment initiation, and effect sizes for statistically significant predictors were small, with the largest odds ratio observed for 1+:NA (mm) (OR = 1.053). In the multivariable model, NSL-NL and SNA remained significant predictors, and the model demonstrated good fit. Associations between cephalometric parameters and orthodontic treatment initiation were selective and predominantly related to vertical skeletal configuration and maxillary incisor position. These findings suggest that cephalometric morphology alone has limited explanatory value for treatment uptake and should be interpreted within a broader multifactorial framework encompassing aesthetic perception, patient preferences, and contextual factors.

Differences in chief complaints based on the molar relationship: A quantitative text analysis of open-ended responses from orthodontic patients.

BackgroundSkeletal Class III malocclusion remains a significant orthodontic challenge because of its multifactorial aetiology, strong genetic influence, and the unpredictability of mandibular growth. Although early protraction facemask therapy is widely advocated for maxillary deficiency, the optimal timing of intervention and long‐term stability remain controversial. This report describes successful management of a growing patient with borderline skeletal Class III malocclusion using a non‐expansion facemask protocol initiated beyond the conventionally recommended early treatment age.Case PresentationA 10.5‐year‐old female presented with anterior crossbite, mild skeletal Class III malocclusion, maxillary retrusion and an anterolateral functional mandibular shift, with a positive family history of mandibular prognathism. Orthopaedic treatment was initiated at cervical vertebral maturation stage CS2 using a non‐expansion protraction facemask protocol, followed by comprehensive non‐extraction fixed appliance therapy.Intervention and OutcomesSerial clinical and cephalometric evaluations demonstrated forward displacement of the maxilla, improvement in sagittal skeletal relationship, favourable dentoalveolar compensation, elimination of functional mandibular shift and improvement in facial profile and smile aesthetics. At treatment completion, stable Class I canine and molar relationships, positive overjet and overbite, improved facial symmetry and balanced facial proportions were achieved.ConclusionThis case highlights that biologically timed protraction facemask therapy, even when initiated beyond the conventional early age, combined with careful case selection and comprehensive fixed appliance treatment, may achieve favourable functional and aesthetic outcomes in selected growing patients with borderline skeletal Class III malocclusion.

ABSTRACTObjectivesMalocclusion and the treatment process can affect the person's quality of life, which includes physical and psychological effects. Classifying the patient accurately is critical to achieving the desired output. This study aimed to improve the current diagnostic process with artificial‐intelligence algorithms using the lateral cephalogram.Materials and MethodsThe study sample consisted of 1014 Arab patients diagnosed with skeletal class I, II, or III. In this study, we used linear discriminant analysis (LDA), random forest (RF), decision tree (DT), K‐nearest neighbors (KNN), support vector machine (SVM), and naive Bayes (NB) as classification models. In addition, we calculated the parameters' importance using two techniques—the impurity decreases and the leave‐one‐feature‐out (LOFO) technique. Finally, we applied an artificial neural network (ANN) to classify the patients accurately.ResultsOne of the influential models presented in this study was the model that included only the parameters Wits appraisal, SNB, SNA, and ML‐NSL angles. It could classify the patients with an accuracy of 0.98. In addition, we applied the leave‐one‐feature‐out technique (LOFO) for multiple random forest models and found that the Calculated_ANB (ANB angle‐individualized ANB) and Wits appraisal were the most important parameters in the random forest models. Besides, age and gender were in 8th and 21st places (out of 26 variables). Furthermore, the decision tree results demonstrated the distinct characteristics of this ethnic group, which were presented by different ranges of ANB angles that define every skeletal class. The results showed that the tree's root classified the patient as skeletal class III when the ANB angle is less than 0.084 degrees, and skeletal class II if the ANB angle is greater than 1.23.ConclusionsIn summary, this research presented a model enabling orthodontists to precisely classify orthodontic patients. Further research should include different ethnic groups to validate our findings.

Body dysmorphic disorder in patients undergoing orthognathic surgery: associations and applicability of screening tools.

Background/Objectives: Systematic assessment of orthodontic treatment needs is essential for prioritizing care in public health programs. The Dental Aesthetic Index (DAI) provides a composite severity score; however, understanding which individual occlusal traits drive severe treatment needs has a practical screening value. This study aimed to determine which occlusal features, categorized using established clinical thresholds, independently associated with severe orthodontic treatment need. Methods: Pretreatment records of 292 patients (141 men, 151 women; aged 13-42 years) were analyzed. The outcome was severe treatment need (DAI ≥ 31). Ten DAI components were categorized using IOTN-DHC severity cutpoints; Angle and skeletal classifications were also assessed. Candidate predictors (p < 0.20) were entered into multivariate logistic regression with backward elimination. Discrimination was assessed by ROC analysis; internal validation used bootstrap resampling and cross-validation. Results: Of the 292 patients, 141 (48.3%) had severe treatment needs. Six occlusal features were independently associated with severe treatment need (all p < 0.001): overjet severity (adjusted odds ratio [OR] = 412.4; 95% confidence interval [CI]: 82.1-2072.1), missing anterior teeth (OR = 29.3; 95% CI: 8.6-99.5), open bite severity (OR = 13.4; 95% CI: 4.6-39.5), diastema (OR = 7.4; 95% CI: 2.4-22.5), molar cusp relationship (OR = 4.7; 95% CI: 2.3-9.5), and anterior spacing (OR = 2.9; 95% CI: 1.5-5.4). The area under the ROC curve was 0.971 (optimism-corrected: 0.968), and 90.8% of the patients were correctly classified by the final model (sensitivity, 89.4%; specificity, 92.1%). Angle classification, skeletal classification, sex, age, and crowding were not included in the final model. Conclusions: Six clinically categorized occlusal features assessed by visual inspection were independently associated with severe orthodontic treatment need in this explanatory analysis, with overjet severity as the dominant determinant. Categorical severity grades based on established clinical thresholds retained strong discriminative information (optimism-corrected AUC = 0.968), suggesting that simplified assessments may be sufficient for the initial screening. Dental and skeletal classifications did not provide an independent predictive value beyond that of occlusal features. External validation is needed before clinical implementation.