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Background Increased interest in intraoral devices like Bionator III, reverse twin block, and removable mandibular retractor (RMR), which modify tissues beneficially. The emerging Orthodontic Removable Traction Appliance (ORTA™) or the lower-clear-plate-based intermaxillary traction (LCP-IMT) has shown promising results, especially in stimulating maxillary growth and inhibiting mandibular growth in Class III malocclusion. Objectives To evaluate the effectiveness of the LCP-IMT against the RMR during the early correction of Class III deformities in growing patients regarding skeletal, dental, and soft tissue variables. Methods A two-arm randomized controlled clinical trial was conducted from July 8, 2023, to June 15, 2024, at the Department of Orthodontics, University of Damascus. It enrolled patients aged 9 to 13 with mild to moderate skeletal Class III malocclusion (ANB + 1 to -3 degrees), an anterior crossbite involving two or more teeth, or an edge-to-edge relationship. Participants had normal or horizontal growth patterns (MM ≤ 35; SN.ManP ≤ 40) and lower incisor inclination (IMPA 85–100 degrees). Patients were randomly assigned to receive orthodontic treatment with either the LCP-IMT or the RMR appliance. Standardized lateral cephalometric images were collected before treatment (T1) and after active treatment (T2), using specialized orthodontic software (Viewbox). Soft- and hard-tissue changes in both groups were evaluated. Blinding was limited to data analysis due to feasibility constraints. Results The sample consisted of 30 patients (12 males and 18 females) ( n  = 15 for each group). All 30 patients were included in the analysis. Skeletal cephalometric analysis revealed no statistically significant differences between the LCP-IMT and RMR groups across all variables ( P  > 0.05), despite slightly greater SNA and ANB changes in the LCP-IMT group. Dentally, both groups showed favorable outcomes; however, the RMR group exhibited significantly greater lower incisor lingual inclination (L1.ManP: − 7.66° vs. − 5.05°, P  = 0.016). Differences between the two groups in overjet, overbite, and soft tissue parameters—including upper lip protrusion and nasolabial angle did not reach statistical significance. Conclusions Both appliances produced comparable short-term dental and soft-tissue improvements; a between-group difference in lower-incisor inclination favored LCP-IMT. These preliminary results require confirmation in larger and longer-term trials. Trial registration This study was retrospectively retrospectively registered in the Clinical Trials database (ID: NCT06596239) on the 11/09/2024. URL: https://clinicaltrials.gov/study/NCT06596239 .

Background Patients with borderline resectable (BR) or locally advanced pancreatic cancer (LAPC) require complex management strategies. This study evaluated the prognostic significance of the perichemotherapy skeletal muscle index (SMI) and carbohydrate antigen 19‐9 (CA 19‐9) in patients with BRPC or LAPC treated with FOLFIRINOX. Methods We retrospectively evaluated 227 patients with BR or LAPC who received at least four cycles of chemotherapy between 2015 and 2020. We analysed chemotherapy response, changes in SMI (ΔSMI, %) on computed tomography (CT) and CA19‐9 to determine their impact on progression‐free survival (PFS) and overall survival (OS). After the early application of loco‐regional treatments (LRT) within 3 months after completing four cycles of chemotherapy, the outcomes were compared between ΔSMI and CA19‐9 subgroups. Results Among 227 patients (median age, 60 years; 124 [54.6%] male) with 97 BR and 130 LAPC, 50.7% showed partial response (PR) to chemotherapy, 44.5% showed stable disease and 4.8% showed progressive disease (PD). Post‐chemotherapy CA19‐9 levels were normalized in 41.0% of patients. The high and low ΔSMI groups (based on the gender‐specific cut‐off of −8.6% for males and −2.9% for females) comprised 114 (50.2%) and 113 (49.8%) patients, respectively. The high ΔSMI group had poorer survival rates than the low ΔSMI group in both PFS (HR = 1.32, p = 0.05) and OS (HR = 1.74, p = 0.001). Multivariable analysis showed that ΔSMI (high vs. low; PFS, HR = 1.39, p = 0.03; OS, HR = 1.82, p < 0.001) and post‐chemotherapy response (PD vs. PR/SD; PFS, HR = 18.69, p < 0.001; OS, HR = 6.19, p < 0.001) were independently associated with both PFS and OS. Additionally, the post‐chemotherapy CA19‐9 (≥ 37 vs. < 37; HR = 1.48, p = 0.01) was an independent predictor for PFS. Early application of LRT after chemotherapy significantly improved PFS and OS in both ΔSMI groups (all p < 0.05). However, it was not beneficial in the group with high ΔSMI and post‐chemotherapy CA19‐9 ≥ 37 (PFS, p = 0.39 and OS, p = 0.33). Conclusions Progressive sarcopenic deterioration after four cycles of chemotherapy was associated with poor survival outcomes in patients with BR or LAPC after FOLFIRINOX. We also investigated the optimal clinical setting for the early application LRTs using the ΔSMI and post‐chemotherapy CA 19‐9.

Twin block appliances are commonly used to treat skeletal class II malocclusion. However, many adverse effects, such as lower incisor protrusion and a bulky nature, can be observed. To overcome these effects, a modified twin block was designed, which uses vacuum-formed hard plates (VFPs) instead of acrylic plates. This clinical trial evaluated the skeletal and dentoalveolar changes resulting from a modified twin block (aesthetic twin block) (ATB) in comparison with conventional twin block (CTB) in addition to levels of esthetics and discomfort. A two-arm parallel group randomized clinical trial was performed at the Department of Orthodontics, University of Damascus, Syria. Fifty-two patients (33 females and 19 males) aged 12.23 ± 0.77 years with skeletal class II division 1 malocclusion caused by mandibular retrognathism were included. The participants were randomly assigned to a study group according to a simple randomization method using a numbered and sealed envelope. The experimental group was treated with an aesthetic twin block, and the control group was treated with a conventional twin block. Sixteen angular variables and eleven seventeen linear variables (measured in millimeters) were evaluated before the treatment (T0) and at the end of the active phase of the treatment (T1) on lateral cephalometric radiographs and dental casts to study the skeletal and dentoalveolar changes, and a questionnaire was used to assess the levels of esthetic and discomfort. There was a statistically significant change in the ANB angle between the ATB group (−2.70 ± 0.84) and the CTB group (−1.92 ± 0.81°) ( P  = 0·002) and between the SNB angle of the ATB group (2.72 ± 1.54°) and the CTB group (1.72 ± 1.41°) ( P  = 0·02). The Jarabak ratio decreased significantly in the CTB group (−0.65 ± 1.37%) ( P  = 0.02) and increased significantly in the ATB group (0.84 ± 1.44%) ( P  = 0.007), with significant differences between the two groups ( P  = 0.000). The change in upper incisor angulation was statistically significant (−1.88 ± 1.48°) for the ATB group and (−3.5 ± 4.18°) for the CTB group ( P  = 0·001). The change in lower incisor angulation was 1.34 ± 2.08° for the ATB group and 3.88 ± 2.47° for the CTB group, which was statistically significant ( P  = 0·000). ATB had more control of vertical growth, lower incisor and upper incisor angulation and was more aesthetically acceptable. Trial registration: (NCT05418413) (14/06/2022).

Divya Siddalingappa,1,* Divya Pai,1,* Chetan Kumar Chiniwalar,2,* Kalyana C Pentapati,3 Arun S Urala1 1Department of Orthodontics and Dentofacial Orthopaedics, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India; 2Vajra Multi Speciality Dental Center, Gangavathi, Karnataka, 583227, India; 3Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India*These authors contributed equally to this workCorrespondence: Arun S Urala, Department of Orthodontics and Dentofacial Orthopaedics, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India, Email arun.urala@manipal.edu Divya Pai, Department of Orthodontics and Dentofacial Orthopaedics, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India, Email pai.divya@manipal.eduPurpose: To compare the effect of maxillary splint high pull head gear (MSHPH) on dentoskeletal structures in growing Class II division 1 patients with a matched control group.Methods: The treatment group (MSHPH) comprised 20 patients who were evaluated at two stages: pretreatment (T1) and post orthopaedic (T2). The control group consisted of 20 untreated class II patients under observation. Intra-group comparisons were done with paired t test and the inter-group comparisons were analyzed with “Mann–Whitney U-test”.Results: Intra-group comparisons in the treated group showed significant decrease in the mean SNA, ANB, N perpendicular to Point A, Point A vertical, PNS vertical, U1 – NA (angular), U1 – SN, U1 – NA (linear), U1 – NF, PtV – U6, overjet and overbite at T2 when compared to T1. However, there was a significant increase in the mean SNB, N-Pog, EMnL, LAFH, at T2. The control group showed significant increase in the mean SNA, ANB, N perpendicular to Pogonion, Effective MxL, Effective MnL, LAFH, Point A vertical, ANS vertical, PNS vertical, U1 – NA (angular), U1 – SN, U1 – NA (linear), U1 – NF, PtV – U6, and overjet at T2 when compared to T1. Inter-group comparisons (T2-T1) showed significantly higher mean in treated group for SNA, SNB, ANB, N perpendicular to Point A, N perpendicular to Pogonion, Effective MnL, U1 – NA (angular), U1 – SN, U1 – NA (linear), U1 – NF, PtV – U6, overjet, overbite, S line Upper Lip and S line to Lower Lil. However, significantly lower values were seen in treated group for Effective MxL, LAFH, Point A vertical, ANS vertical, and PNS vertical.Conclusion: MSHPH held the maxilla without changes in the palatal plane. Thus, normal skeletal relationships resulted from inhibiting maxillary growth and preserving natural mandibular development in the treatment group.Keywords: dental, malocclusion, maxillary traction splint, skeletal change, maxillary prognathism, SDG 3, SDG 4

Background. The present study evaluated condylar position changes using cone beam computed tomography (CBCT) in treating Cl II malocclusion with the twin block and clear functional jaw corrector (CFJC) appliances. Methods. In this RCT, we included 60 patients, with 30 in each treatment group (control group: twin block appliance, case group: CFJC appliance), randomly allocated using a lottery system. A twin block appliance or CFJC was fabricated for each patient following the protocol. Pre- and post-treatment records were collected over twelve months at 0-, 6- and 12-month intervals using cephalograms, CBCT, and questionnaires assessing the patient perception of the appliance. Results. Both groups showed significant improvements in malocclusion. Cephalometric analysis showed statistically significant differences between the two groups in SNB, ANB, and U1-NA. In comparing the two groups, significant differences were found in Arnett’s soft tissue parameters, including upper lip to E line, lower lip to E line, upper lip protrusion, upper lip length, lower lip length, lower 1/3 of the face, maxillary first incisor exposure, and mandibular height in the CFJC group. The intergroup comparison of projections to TVL (true vertical line) also showed significant differences across all parameters in the CFJC group. Furthermore, significant disparities in CBCT parameters were observed between the groups, specifically in condylar position, condylar height, and anterior joint space. Also, significant differences in patient comfort and perception of the appliance were observed, highlighting better compliance with the CFJC appliance. Conclusion. The CFJC appliance is a top choice for Cl II malocclusion due to its superior effectiveness in skeletal, dental, and soft tissue improvements and significant condylar remodeling. Additionally, patients showed better compliance and acceptance of the CFJC appliance compared to traditional options, enhancing its clinical advantage in orthodontic practice.

Background Low-intensity electrical stimulation (LIES) is one of the recent physical techniques employed to accelerate orthodontic tooth movement and reduce treatment time. Objective This trial aimed to assess the effectiveness of the LIES technique in shortening the en-masse retraction time and evaluate skeletal, dental, or soft tissue changes on lateral cephalograms. Methods Young adult patients with a Class II division I malocclusion who visited the Department of Orthodontics at the University of Damascus Faculty of dentistry, between October 2022 and February 2023 and met specific inclusion criteria were included in this two parallel arms randomized controlled trial (RCT). The patients were randomly distributed into: the LIES group and the traditional en-masse retraction (TRAD) group. Computer-generated random numbers were used for the patient assignment. Blinding was performed only during data extraction and analysis. Mini-screws were used for anchorage during the en-masse retraction, and a force of 250 g was applied bilaterally with Nickel-Titanium springs. In the LIES group, each upper anterior tooth received a 15–20 µA electrical stimulation for five uninterrupted hours daily using an intraoral removable electrical stimulation device. The assessed outcomes were the required time for completing the en-masse retraction phase and the skeletal, dental, and soft tissue changes using lateral cephalograms at specific time points (T0: baseline; T1: before en-masse retraction; T2: end of en-masse retraction). Results Out of 127 patients were examined, 36 adult patients were enrolled and entered data analysis with a mean age of 20.91 ± 2.24 years. The en-masse retraction phase in the LIES group took a significantly shorter time than that in the TRAD group by a mean of 2.69 months ( P  < 0.001). Insignificant differences were observed between the two groups in almost all measured variables. In addition, a slight anterior rotation of the mandible was observed in both groups. A greater horizontal retraction of the apices of the upper incisors was seen in the LIES group compared to the TRAD group ( P  = 0.005). Conclusions The LIES shortened the required time for the en-masse retraction of the upper anterior teeth by approximately 30% compared to the traditional method. No significant differences between the two groups were observed in skeletal and soft tissue variables. However, a greater bodily movement of the upper incisors was noted in the LIES group. Registration This trial was retrospectively registered in the Clinical Trials database (ID: NCT06639204) and it was first posted on 15/10/2024.

Background Sickle cell disease and thalassemia are inherited hematological disorders that are common worldwide. These patients suffer from chronic hemolytic anemia, which can result in bone marrow dysfunction and, in rare cases, extramedullary hematopoiesis. These pathophysiological changes can predispose patients to sinus complications or misdiagnosis in imaging studies. Objective Evaluate the maxillary sinus abnormalities in patients with β‐thalassemia, sickle cell anemia, and sickle cell–beta thalassemia. Methods A multicenter, case–control study was conducted, including 212 participants, categorized into four groups: control (n = 100), sickle cell anemia (n = 51), β‐thalassemia (n = 15), and sickle cell‐beta thalassemia (n = 46). Demographic information, laboratory parameters (mean hemoglobin levels and hemoglobin electrophoresis), history of hydroxyurea use, and blood transfusion were recorded. Computed tomography was used to assess sinus wall thickness, extramedullary hematopoiesis, and related sinonasal abnormalities. Results Significant maxillary sinus wall thickening across all disease groups was found, with the β‐thalassemia exhibiting the most pronounced changes (p < 0.001). A negative correlation was observed between hemoglobin levels and sinus wall thickness in sickle cell anemia. Extramedullary hematopoiesis in the paranasal sinuses, although rare, was identified in five patients with β‐thalassemia. Obstruction of the ostiomeatal complex was observed in 14.3% of the β‐thalassemia, 13.7% of sickle cell anemia, and 6.5% of sickle cell–beta thalassemia. Conclusion Our findings reveal significant maxillary sinus wall thickening in β‐thalassemia, sickle cell anemia, and sickle cell–beta thalassemia. Recognizing these structural changes is important for radiologists and otolaryngologists, as they may resemble other pathologies and lead to diagnostic challenges if not carefully interpreted. Level of Evidence 4. This study assessed CT findings in patients with β‐thalassemia, sickle cell anemia, and sickle cell–β‐thalassemia. Significant sinus wall thickening and rare cases of paranasal sinus extramedullary hematopoiesis were observed. These findings may resemble other pathologies and present diagnostic challenges.

Background/Objectives: The nasomaxillary complex is a compound anatomical structure in which the correlation between changes in palatal width and height has been poorly investigated. Methods: A three-year prospective study with 28 patients treated with printed expanders was conducted. Measurements on CBCT images were performed before and after treatment; the width and height parameters were measured on a coronal slice of a CBCT image at the level of the first molars and upper first molar inclination relative to the palatal plane. Results: A significant difference was found between the values measured before and after treatment, including an increase in the measured width parameters and a statistically significant decrease in palatal height (0.75 ± 0.97). The mean change in the upper molar inclination was not significant (tooth 16: 0.60 ± 6.42; tooth 26: 2.19 ± 4.51). The regression analysis did not establish a significant correlation between the expansion of the maxillary occlusal width and palatal height change or a significant correlation between the increase in the upper molar inclination and palatal height change. Conclusions: The use of a printed tooth-borne expander causes predictable and reproducible skeletal changes. It is a feasible treatment option, allowing for precise screw positioning to achieve bodily movement of the teeth and decrease the change in molar inclination.