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The objective of this prospective study was to evaluate whether magnetic resonance imaging (MRI) is equivalent to lateral cephalometric radiographs (LCR, \"gold standard\") in cephalometric analysis. The applied MRI technique was optimized for short scanning time, high resolution, high contrast and geometric accuracy. Prior to orthodontic treatment, 20 patients (mean age ± SD, 13.95 years ± 5.34) received MRI and LCR. MRI datasets were postprocessed into lateral cephalograms. Cephalometric analysis was performed twice by two independent observers for both modalities with an interval of 4 weeks. Eight bilateral and 10 midsagittal landmarks were identified, and 24 widely used measurements (14 angles, 10 distances) were calculated. Statistical analysis was performed by using intraclass correlation coefficient (ICC), Bland-Altman analysis and two one-sided tests (TOST) within the predefined equivalence margin of ± 2°/mm. Geometric accuracy of the MRI technique was confirmed by phantom measurements. Mean intraobserver ICC were 0.977/0.975 for MRI and 0.975/0.961 for LCR. Average interobserver ICC were 0.980 for MRI and 0.929 for LCR. Bland-Altman analysis showed high levels of agreement between the two modalities, bias range (mean ± SD) was -0.66 to 0.61 mm (0.06 ± 0.44) for distances and -1.33 to 1.14° (0.06 ± 0.71) for angles. Except for the interincisal angle (p = 0.17) all measurements were statistically equivalent (p < 0.05). This study demonstrates feasibility of orthodontic treatment planning without radiation exposure based on MRI. High-resolution isotropic MRI datasets can be transformed into lateral cephalograms allowing reliable measurements as applied in orthodontic routine with high concordance to the corresponding measurements on LCR.

IntroductionCompensatory mouth breathing, caused by nasopharyngeal obstructive diseases, is the main cause of hyperdivergent mandibular retrognathia in children. Such deformities require effective growth guidance before pubertal growth peaks. The traditional mandibular advancement device, twin block (TB), can guide the forward development of the mandible. However, the side effect of increasing the vertical dimension of the lower facial third, worsens the facial profile of children with divergent growth trends. To solve this problem, a modified TB (LLTB) appliance was designed to control the vertical dimension by intruding incisors and inhibiting the elongation of posterior teeth during the advancement of the mandible, which could avoid the side effects of traditional appliances and effectively guide the growth of the mandible in a normal direction.Methods and analysisThe study was designed as a single-centre, single-blind, randomised, parallel controlled trial. We aim to enrol 60 children aged 9–14 years with hyperdivergent skeletal class II malocclusion, using a 1:1 allocation ratio. The participants were will be randomly assigned to receive either the TB or LLTB treatment. The primary outcome will be a change in the angle of the mandibular plane relative to the anterior cranial base. The secondary outcomes will include changes in the sagittal maxillomandibular relation, occlusal plane, facial height, morphology of the mandible and upper airway width. Safety endpoints will also be evaluated.Ethics and disseminationEthical approval was obtained from the ethics committee of Shanghai Stomatological Hospital. Both participants and their guardians will be fully informed of the study and sign an informed consent form before participating in the trial. The results will be publicly available in peer-reviewed scientific journals.Trial registration numberChiCTR2000035882.

Background Several appliances have been used for correction of developing skeletal Class II, including different myofunctional appliances as Twin block (TB)as well as the new pre-fabricated Myobrace (MB) appliance. However, the effects of these devices on the pharyngeal airways have not been compared in the literature. Thus, the aim of this study was to compare the effects of two Class II correction appliances; TB and MB on the sagittal pharyngeal airway dimension (SPAD), including the nasopharyngeal airway area (NPAA), the oropharyngeal airway area (OPAA), and the laryngopharyngeal airway area (LPAA). Methods This is a two parallel arms randomized comparative clinical trial. Twenty-six children of 9–12 years with Skeletal Class II malocclusion due to mandibular deficiency and normal maxillary growth as confirmed by lateral cephalometric X-ray readings (ANB angle > 4° and SNB angle < 78) and Cervical vertebral maturational index (CVMI) 1 or 2 were randomly assigned into two equal groups. Group I: TB, Group II: MB (prefabricated functional appliance, Myofunctional Research Co., Australia). Lateral cephalograms were taken for all patients in both groups before treatment (T1) and after treatment (6 months later) (T2). The primary aim was to assess pre and post treatment changes in the SPAD in each group, and compare between the two study groups. The secondary aim was to evaluate the sagittal skeletal measurements such as the SNA, SNB, ANB, Wits appraisal, as well as vertical skeletal measurements represented by the Frankfurt-mandibular plane angle (FMA) measured pre- and post-treatment. The independent samples t-test was used to compare the two study groups, and the mean difference and 95% confidence intervals (CI) were computed. The paired samples t-test was used to compare various parameters between T1 and T2 within each group. The cutoff for significance was p -value < 0.05. Data were analyzed using IBM SPSS for Windows (Version 26.0). Results By Comparing changes in airway measurements within each group, it was found that NPAA, OPAA, and LPAA increased significantly after treatment within each group of MB and TB. TB group showed significantly higher mean difference (T2-T1) in both NPAA and OPAA than MB group with 28.39 (± 56.75) and 40.46 (± 52.16) respectively. The increase in LPAA values was not statistically significant at (T2-T1) between both groups. Regarding skeletal changes, there was a significant increase in the SNB values between T1 and T2 within each group with 2.82 (± 3.32) for MB group and 3.79 (± 3.06) for TB group Moreover, there was a significant decrease in the ANB values between T1 and T2 within each group by 2.42 (± 2.70) for MB group and 3.06 (± 1.14) for TB group. Similarly, there was a significant decrease in the ANB values between T1 and T2 within each group by -2.13 (± 0.62) for MB group and − 2.46 (± 0.72) for TB group. No significant differences were found between both groups in SNA, SNB, ANB and Wits appraisal at p  = 0.06, p  = 0.45, p  = 0.43 and p  = 0.22 respectively. FMA did not show significant difference between T1 and T2 within each group, nor showed a significant mean difference between both groups at T2-T1. Conclusions TB was more effective than MB in improving the upper (NPAA) and middle (OPAA) airways, while no difference was found regarding the lower airway (LPAA). Both TB and MB reduced the severity of developing skeletal class II due to mandibular retrognathism by forward posturing of the mandible. Thus, patients with airway problems would benefit more from TB than MB.

Background Anterior open bite is a challenging condition for pediatric dentists and orthodontists as it causes aesthetic, speech, feeding, and psychological problems; this emphasizes the need for early diagnosis and interception of this malocclusion. Aim This study aimed to evaluate the effects of prefabricated metal-bonded tongue tamers and customized bonded spurs in the early treatment of anterior open bite. Materials and methods A sample of seventy-five children aged 7–9 years were assigned into three groups in which anterior open bite was treated using tongue tamers (group-I), customized composite bonded spurs(group-II), and conventional fixed palatal cribs (group-III). Study model and cephalometric x-ray evaluations were done before and after a three-month follow-up. Data was gathered and statistically analyzed using ANOVA and Bonferroni tests. Results Model overbite at central and lateral incisors was increased in all groups. The highest increase was found in group-I(3.16 ± 1.17, 2.81 ± 0.94)and group-III(3.08 ± 1.10,2.99 ± 1.00) though the difference was not statistically significant. Also, cephalometric overbite was non-significantly increased in all groups with a high increase in group-III(3.13 ± 1.10). Overjet decreased in all groups, with the greatest reduction observed in group-I(-2.58 ± 1.02 and -2.47 ± 0.80 in model and cephalometric respectively) and was significantly different from group-II using pairwise analysis. There was a decrease in SNA and ANB in all groups with more significant improvement in groups-I(-1.20 ± 0.88,-1.65 ± 0.74) and -III(-1.31 ± 0.92, -1.62 ± 0.75) than group-II(-0.63 ± 0.46, -0.90 ± 0.43). Moreover, FMA measurements decreased significantly in group-I (-2.6 ± 1.11). Regarding SNB measurement, there was a non-significant increase in all three groups with the highest increase in group-I(0.49 ± 0.48) followed by group-III(0.34 ± 0.63). The U1/FHP and L1/GoGn angles were non-significantly decreased in all tested groups with the highest decrease in group-I(-1.76 ± 1.00 and-2.54 ± 0.87 respectively). Conclusion Early treatment of anterior open bite, along with tongue tamers' simplicity and aesthetics promoted the malocclusion correction and occlusal function restoration. Trial registration ClinicalTrials.gov, NCT05792553 , “Effects of Tongue Tamers as an Early Treatment of Anterior Open Bite”, Retrospectively registered: 31/03/2023.

Background: Extrauterine growth restriction is common among very low birth weight infants (VLBW, BW <1,500 g). Optimal postnatal nutrient supply is essential to limit growth restriction and ensure adequate growth and neurodevelopment. Objectives: We compared an enhanced postnatal nutrient supply to a standard supply and evaluated the effects on growth velocity, head circumference growth and cerebral maturation - the latter by magnetic resonance diffusion tensor imaging (DTI). We hypothesized increased growth velocity, head circumference growth and decreased mean diffusivity (MD) in cerebral white matter (WM) areas, suggesting improved cerebral maturation among infants on the enhanced nutrient supply. Methods: In this randomized controlled trial, infants on the enhanced nutrient supply received increased amounts of energy, protein, fat, essential fatty acids and vitamin A until discharge. DTI was performed close to term equivalent age. Outcomes were growth velocity, head circumference growth and WM mean diffusivity. Results: Among the 50 included infants, 14 in the intervention group and 11 controls underwent a successful DTI. Infants on the enhanced diet achieved improved growth velocity (16.5 vs. 13.8 g/kg/day, p = 0.01) and increased head circumference (Δz score: 0.24 vs. -0.12, p = 0.15). A significantly lower MD was seen in a large WM area such as the superior longitudinal fasciculi (1.19 × 10 -3 vs. 1.24 × 10 -3 mm 2 /s, p = 0.04, adjusted for age when scanned). Conclusions: Enhanced nutrient supply to VLBW infants is associated with improved growth velocity, increased head circumference growth and decreased regional WM mean diffusivity, suggesting improved maturation of cerebral connective tracts.

Trial design Parallel. Objective To compare skeletally anchored Carriere Motion appliance (CMA) for distalization of the maxillary buccal segment vs. Essix anchored CMA. Methods Thirty-two class II malocclusion patients were randomly allocated into two equal groups. One group was treated with infrazygomatic (IZC) miniscrew- anchored CMA (IZCG) and the other group treated with Essix retainer- anchored CMA (EXG). Two lateral cephalograms and two digital models for upper and lower arches were taken for each patient: immediately before intervention and after distalization had been completed. Results Distalization period was not significantly different between the two groups. In contrast to EXG, IZCG showed insignificant difference in ANB, lower incisor proclination, and mesial movement of the lower first molar. There was significant rotation with distal movement of maxillary canine and first molar in both groups. Conclusion IZC anchored CMA could eliminate the side effects of class II elastics regarding lower incisor proclination, mesial movement lower molars with a more significant amount of distalization of the maxillary buccal segment but with significant molar rotation. Trial registration The ClinicalTrials.gov Protocol Registration and Results System (PRS) has this RCT registered as (NCT05499221) on 12/08/2022.

Background Anterior open bite (AOB) malocclusion usually represents a complicated and advanced orthodontic problem. The skeletal variant of AOB used to be treated with a combined orthodontic and surgical approach, until the posterior segments’ intrusion has been validated as an alternative, effective and conservative treatment modality for such cases with comparable outcomes to the surgical approach. The objective of this two-arm parallel randomized clinical trial was to compare the effects of mini-screw supported maxillary versus bi-maxillary buccal segments’ intrusion on the amount of anterior open bite closure. Methods Twenty-two adult patients aged 17–25 years, with skeletal open bite and anterior dental separation of 3–8 mm were randomized to either the comparator (Maxillary Intrusion with Consolidation of mandibular buccal segments-MIC) or intervention (Bimaxillary buccal segments’ intrusion-BMI) groups. Miniscrew-assisted buccal segments’ intrusion was instituted using fixed appliances on rigid stainless steel archwires (19 × 25 stainless steel) via nickel-titanium coil springs in the maxilla and memory chains in the mandible. The intrusion force was 200 g per maxillary buccal segment in both groups, and it was 150 g for each mandibular posterior segment in the BMI group. Duration of intrusion was 6 months. Results Anterior open bite was significantly closed in both groups with means of 3.8 ± 0.84 (95% confidence interval [CI] 3.2–4.4) and 3.84 ± 1.47 mm (CI;2.8–4.9) for the MIC and BMI groups, respectively with no significant difference between them (p-value < 0.05). Maxillary posterior teeth experienced significant intrusion in both groups, with a mean of 2.89 ± 1.13 mm (CI;2.63–3.14) in the MIC group and 2.26 ± 1.62 mm (CI;1.89–2.62) in the BMI group. Statistically significant mandibular posterior teeth intrusion occurred in both groups with means of 0.86 ± 0.91 (CI;0.65–1.06) and 0.33 ± 0.84 mm (CI;0.14–0.52) in the BMI and MIC groups, respectively, with a statistically significant difference of 0.53 ± 0.14 (CI;0.25–0.8) mm. However, such difference was considered clinically insignificant. Conclusions Anterior open bite closure could be successfully achieved with maxillary buccal segments intrusion without the need for active intrusion of the mandibular posterior segments, as long as the latter are efficiently consolidated. Trial registration The trial was prospectively registered at clinicaltrials.gov with an identifier number of NCT04713280.

Background Early intervention in Class III malocclusion aims to prevent the need for surgery in adulthood by enhancing upper jaw growth while limiting lower jaw development. Although traditional facemask treatment remain common, bone-anchored devices are increasingly used, claiming better skeletal control and patient compliance. However, strong evidence supporting these advantages is limited. Methods Single-center, parallel-group, randomized controlled trial with 1:1 allocation ratio. Participants:  28 growing Class III patients (mean age 9.7 ± 1.3 years) in mixed dentition with skeletal class III malocclusion. Interventions:  Patients were randomly assigned to either hybrid hyrax with facemask (HH + FM, n = 14) or hybrid hyrax with mentoplate (HH + MP, n = 14). All received Alt-RAMEC protocol expansion. FM group used 360–400 g/side elastic traction 12–14 h daily; MP group used 185 g/side continuous traction. Objective:  To compare 5-year three-dimensional (3D) skeletal effects between HH + FM and HH + MP protocols. Outcome:  Primary outcome was 3D volumetric changes of upper and lower jaw at 1 year (T1) and 5 years (T2) post-treatment, measured using low-dose CT scans. Randomization: 28 patients were allocated to either treatment-protocols using sequentially numbered opaque, sealed envelopes. The randomization sequence was generated with a 1:1 allocation ratio. Blinding: Due to the nature of the trial, the operator and children could not be blinded to the treatment allocation. However, blinding was used when assessing the outcomes. Results Follow-up: one patient was lost at the one-year follow-up and an additional three patients were lost at the 5-year-follow-up. Outcomes: At T2 (5 years), maxillary advancement was identical between both groups (0.85 mm ± 0.5). Mandibular growth control showed minimal difference (FM: − 0.01 mm ± 0.24; MP: 0.10 mm ± 0.33). No significant differences were found between groups for any skeletal measurements ( p  > 0.05). Male patients showed lager mandibular changes both signed ( p  < 0.03) and unsigned ( p  < 0.01). Harms: minor harms were encountered with the anchor hooks (fracture or mucosal irritation), however none led to treatment cessation. Conclusions Both protocols demonstrated comparable long-term skeletal effects in Class III correction. Treatment choice should be based on individual patient factors rather than assumed mechanical advantages.

Objective The objective of the study is to evaluate the skeletal, dentoalveolar and soft tissue changes before and after treatment with Alt-RAMEC protocol and protraction headgear in comparison to the controls. Material and methods A quasi experimental study was conducted in the orthodontic department on 60 patients of cleft lip and palate. These patients were divided into two groups. Group I was the Alt-RAMEC group that underwent Alt-RAMEC protocol followed by facemask therapy while group II was the control group that underwent RME and facemask therapy. Total treatment time in both the groups was approximately 6 to 7 months. Mean and standard deviation was calculated for all the quantitative variables. Pre and post treatment changes between treatment and control groups were made using paired t-test. Intergroup comparison between treatment and control group was analyzed using independent t-test. Significance for all tests was predetermined at a P -value of  ≤ 0.05. Results The Alt-RAMEC group showed significant forward movement of maxilla and improvement in the maxillary base. A remarkable improvement in SNA was seen. The overall outcome was better maxillo-mandibular relationship as shown by positive ANB values and angle of convexity. More effect on maxilla and least effect on mandible was notified with Alt-RAMEC protocol and facemask therapy. Improvement in transverse relationship was also evident in the Alt-RAMEC group. Conclusion Alt-RAMEC protocol in combination with protraction headgear is a better alternative to treat cleft lip and palate patients in comparison to the conventional protocol.

Background: This study aimed to evaluate the effect of applying digital technology in orthodontic learning, students' new skills and satisfaction towards it. Methods: In total, 94 undergraduates of stomatology were recruited and randomly allocated to two groups. According to the cross-over design, both groups completed cephalometric measurements through the traditional hand-drawn method and digital technology (the Dolphin software) in different orders. By traditional hand-drawn method, students need to depict the outlines of the craniofacial anatomical structures on the sulfuric transfer paper first, then marked the measurement points and completed the measurement of line spacings and angles. By digital technology, they should mark the points in the software and adjust the automatically generated outlines of the structures and obtained the results. Besides, an online questionnaire was designed to investigate students' attitudes toward the digital technology. Two professional orthodontists were invited as instructors. They measured a lateral cranial radiograph by two methods with one week's interval, and their intra- and inter-class correlation coefficient were measured. The means of their measurements were set as standards. Results: The inter- and intra-ICC of two instructors surpassed 90%, and there were no significant differences between their measurements, and the measurements by two methods. There were significant differences of students' measurements ( P 1-SNA<0.01, P 1-SNB=0.01 and P 1-L1-NB (mm)<0.01) between the traditional method and digital technology. Besides, the most results of digital technology were closer to the standards than those of traditional method, including five items with statistical significance ( P 2-SNB<0.05, P 2-L1-NB (mm)<0.01, P 2-FMA<0.05, P 2-FMIA<0.05, P 2-IMPA<0.01), while three items were the opposite ( P 2-SNA<0.05, P 2-ANB (mm)<0.01, P 2-NA-PA<0.01). The questionnaire showed more students preferred digital technology compared with traditional method and 72% of participants mastered 50-80% of cephalometric knowledge after the course.