European journal of orthodontics最新文献

{"title":"Treatment outcomes of different TAD patterns in clear aligner therapy for maxillary incisor retraction after premolar extraction.","authors":"Xu Zhang, Zhizun Wang, Ruiting Ren, Delong Li, Wei Zheng, Li Mei, Yu Li","doi":"10.1093/ejo/cjag060","DOIUrl":"https://doi.org/10.1093/ejo/cjag060","url":null,"abstract":"<p><strong>Objective: </strong>The integration of temporary anchorage devices (TADs) to aid clear aligner therapy (CAT) represents an evolving strategy that has gained expanding application over the past decade. This retrospective cohort study aimed to investigate the treatment outcomes of CAT cases involving maxillary incisor retraction following premolar extraction, managed with assistance of various TAD patterns.</p><p><strong>Subjects and methods: </strong>Adult premolar extraction CAT cases were included in this retrospective cohort study. The maxillary central incisors (U1) were grouped based on the TAD pattern for their retraction: Non-TAD (n = 54), posterior TADs only (P-TADs; n = 50), or combined anterior and posterior TADs (AP-TADs; n = 46). Pretreatment and post-treatment CBCTs quantified U1 lingualization, intrusion, retroclination and potential side effects such as apical root resorption (ARR), pulp chamber reduction and palatal dehiscence incidence.</p><p><strong>Results: </strong>P-TADs and AP-TADs patterns achieved greater U1 lingualization than the Non-TAD group. Vertical control differed markedly: AP-TADs achieved U1 intrusion (1.07 ± 1.64 mm), whereas P-TADs and Non-TAD showed U1 extrusion (-0.46 ± 1.12 mm and -1.51 ± 1.29 mm, respectively). U1 retroclination was over 10° in all three groups. AP-TADs exhibited greater ARR (1.31 ± 0.91 mm) and a higher proportion of Grade III ARR than the other groups. In regression analysis, the intrusion achieved was the strongest independent predictor of ARR. Pulp chamber reduction and palatal dehiscence incidence was similar among groups.</p><p><strong>Limitations: </strong>Residual confounding may persist due to the inherent limitations of retrospective study designs.</p><p><strong>Conclusions: </strong>In CAT cases involving maxillary incisor retraction following premolar extraction, P-TADs and AP-TADs patterns were associated with notable clinical treatment outcomes. These preliminary findings may provide prognostic indication for the management of such cases in the future.</p>","PeriodicalId":11989,"journal":{"name":"European journal of orthodontics","volume":"48 5","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148688663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frontal sinus morphology and maturation determination.","authors":"Hatice Kök","doi":"10.1093/ejo/cjag059","DOIUrl":"https://doi.org/10.1093/ejo/cjag059","url":null,"abstract":"<p><strong>Aim: </strong>To determine the relationship between frontal sinus morphometric measurements and established maturation indicators obtained from hand-wrist and lateral cephalometric radiographs, and to evaluate the diagnostic performance of frontal sinus morphometric measurements in discriminating growth and developmental stages.</p><p><strong>Materials and methods: </strong>This retrospective study analysed radiographs of 240 patients aged 9-19 years who underwent simultaneous hand-wrist and cephalometric imaging. Patients were categorized into six cervical vertebral maturation stages (CVS), with 20 females and 20 males in each stage. Hand-wrist (HWS), cervical vertebra (CVS), and dental maturation (DS) stages were assessed. Frontal sinus measurements included maximum height (FSHeight), maximum width (FSWidth), frontal sinus index (FSIndex), area (FSArea), and perimeter (FSPerimeter). Spearman's Rho assessed correlations, and ROC analysis evaluated diagnostic performance with cut-off-based accuracy rates. Reliability was examined using the Kappa coefficient, Kendall's tau-b, and intraclass correlation coefficient (ICC).</p><p><strong>Results: </strong>After Benjamini-Hochberg false discovery rate (FDR) correction, no significant correlations were found between HWS or DS stages and FSHeight in male patients, or between CVS or DS stages and FSIndex. In females, FSArea showed the highest discriminatory performance for classifying the transition from pre-pubertal to pubertal stage (AUC = 0.794; P < 0.001). In males, FSWidth showed the strongest discriminatory performance (AUC = 0.817; P < 0.001). For the transition from the pubertal to post-pubertal stage, FSWidth showed the highest discriminatory performance (AUC = 0.846; P < 0.001), and all frontal sinus measurements were statistically significant in both sexes.</p><p><strong>Conclusion: </strong>Frontal sinus morphometry showed high reliability and meaningful associations with age and maturation indicators. However, as AUC values ranged from moderate to good (0.655-0.846) and diagnostic performance varied by sex, maturation system, and transition stage, frontal sinus morphometry should be regarded as a supplementary rather than a standalone or definitive indicator of skeletal maturation, pending longitudinal validation.</p>","PeriodicalId":11989,"journal":{"name":"European journal of orthodontics","volume":"48 5","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13490868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microplastics and orthodontic aligners: another hype?","authors":"Theodore Eliades, Despina Koletsi","doi":"10.1093/ejo/cjag061","DOIUrl":"https://doi.org/10.1093/ejo/cjag061","url":null,"abstract":"","PeriodicalId":11989,"journal":{"name":"European journal of orthodontics","volume":"48 5","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148758146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated prediction of hand-wrist maturation stage from lateral cephalometric and panoramic radiographs using a deep learning approach.","authors":"Merve Edik, Fatma Çelebi, Meryem Etöz","doi":"10.1093/ejo/cjag054","DOIUrl":"10.1093/ejo/cjag054","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to predict hand-wrist developmental stages, the most reliable indicator of skeletal maturation, from panoramic radiographs (PRs) and lateral cephalometric radiographs (LCRs) using deep learning and to compare the two methods. The goal was to provide a rapid and objective method for growth assessment in orthodontic planning without additional radiation exposure.</p><p><strong>Methods: </strong>A total of 3703 patients who underwent hand-wrist radiographs (HWRs), PRs, and LCRs prior to orthodontic treatment were retrospectively analyzed. HWRs were classified according to Björk's 9-stage system and reduced to 5- and 3-group schemes. YOLOv5 was used for automated reference point detection, and the extracted regions were classified using a multimodal deep learning framework. EfficientNet-B0 was used for 9-stage classification, and EfficientNet-B4 was used for 5- and 3-group classifications. Clinical variables (age, gender) were included, and hybrid loss strategies addressed class imbalance while preserving sequential stage relationships. Performance metrics included accuracy, recall, mAP@0.5, balanced accuracy, Cohen's Kappa coefficient, and detailed error analysis; 5-fold cross-validation and ensemble learning were used to improve robustness.</p><p><strong>Results: </strong>YOLOv5 detected tooth roots in PRs (accuracy 92.5%, recall 93.3%, mAP@0.5 = 0.942) and cervical vertebrae in LCRs (accuracy 98.9%, recall 99.9%, mAP@0.5 = 0.995). In PRs, the standard accuracy in 9-, 5-, and 3-stage classifications was 0.3648, 0.5307, and 0.7520, respectively, while in LCRs, the standard accuracy in 9-, 5-, and 3-stage classifications was 0.4350, 0.6336, and 0.8975, respectively.</p><p><strong>Conclusion: </strong>Deep learning can reliably automate skeletal maturation assessment across imaging methods and resolutions. Appropriately optimized models provide valuable decision support in orthodontic treatment, increasing efficiency and consistency.</p>","PeriodicalId":11989,"journal":{"name":"European journal of orthodontics","volume":"48 5","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does nasal airflow obstruction influence maxillary canine impaction? A fluid dynamics and quantitative tongue posture study.","authors":"Tomohiro Kizuki, Kei Maeo, Yukari Suzuki, Mayu Noda, Hitomi Kuramoto, Takamasa Kitamura, Yuki Akazawa, Hitomi Ishii, Ryuzo Kanomi, Tomonori Iwasaki","doi":"10.1093/ejo/cjag058","DOIUrl":"https://doi.org/10.1093/ejo/cjag058","url":null,"abstract":"<p><strong>Background/objectives: </strong>Maxillary buccal impacted canines (BIC) can cause root resorption of the adjacent incisors, making early detection critical. However, the etiological factors underlying BIC remain unclear. In this study, we aimed to investigate the association between nasal airflow status and tongue posture in patients with BIC.</p><p><strong>Methods: </strong>Ninety-three children with BIC were classified based on canine axis inclination into mild (n = 24, mean age: 9.24 years), moderate (n = 23, mean age: 9.12 years), and severe (n = 46, mean age: 9.67 years) impaction groups. A control group comprised 31 children without BIC (mean age: 9.66 years). Cone-beam computed tomography assessed maxillofacial morphology, maxillary and mandibular arch widths and molar inclination, intraoral airway volume (indicator of low tongue posture), and nasal airway pressure using computational fluid dynamics.</p><p><strong>Results: </strong>Maxillary first molar width was significantly smaller in the severe impaction group (32.4 mm) than in the control group (34.0 mm). Nasal airway pressure and intraoral airway volume were significantly greater in the severe impaction group (1328.2 Pa; 2.31 cm3) than in the control group (50.2 Pa; 0.53 cm3). Nasal airway obstruction and low tongue posture were significantly more prevalent in the severe impaction group (78.2% and 80.4%) than in the control group (9.6% and 22.5%).</p><p><strong>Limitations: </strong>Study limitations include the retrospective nature, restricted sample age, and lack of evaluation of genetic and local factors.</p><p><strong>Conclusions/implications: </strong>BIC are associated with dental arch morphology, nasal airway obstruction, and low tongue posture.</p>","PeriodicalId":11989,"journal":{"name":"European journal of orthodontics","volume":"48 5","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of the registration of a digital dental cast or intraoral scan into a stereophotogrammetric image of the face: a systematic review.","authors":"Anouk E H C Go, Rutger H Schepers, Hans L L Wellens, Johan Jansma, Anne-Marie Kuijpers-Jagtman","doi":"10.1093/ejo/cjag057","DOIUrl":"10.1093/ejo/cjag057","url":null,"abstract":"<p><strong>Background: </strong>Recent technological advances enable integration of digital dental casts or intraoral scans with 3D facial stereophotogrammetry. However, evidence on the accuracy of this integration remains limited.</p><p><strong>Objectives: </strong>To assess the level of evidence regarding the accuracy of the integration of a digital dental cast or intraoral scan into a 3D-facial image, in comparison to a full face CBCT scan in healthy growing and nongrowing patients.</p><p><strong>Search methods: </strong>MEDLINE (PubMed), EMBASE, Web of Science, Cochrane Library were searched. A manual search was performed of reference lists of included articles.</p><p><strong>Selection criteria: </strong>Inclusion criteria were studies investigating the integration of a digital dental cast or intraoral scan into a 3D stereophotogrammetric picture of the face, with a full face CBCT as a comparator. All study designs except case reports were included.</p><p><strong>Data collection and analysis: </strong>A pilot assessment was conducted, to synchronize the reviewers' criteria for data extraction. After data extraction, a Risk of bias (RoB) assessment was performed using the Quality assessment of diagnostic accuracy studies (QUADAS-2) tool. Certainty of the evidence was assessed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool.</p><p><strong>Results: </strong>Four eligible studies were identified and two more after updating the literature search. All reviewed studies confirmed feasibility of integrating intraoral scans with 3D facial images. The QUADAS-2 assessment revealed a high risk of bias for all included studies. Certainty of evidence concerning the accuracy was very low (GRADE). Due to heterogeneity concerning registration procedures and anatomical landmarks between the included studies, a qualitative description analysis of the results was made.</p><p><strong>Conclusions: </strong>The accuracy of the registration of a digital dental cast or intraoral scan into a facial scan is clinically acceptable. Most, but not all outcomes met the 2 mm or 2 degree threshold, depending on anatomical region, image acquisition, and measurement method. A 3D image of the face with an integrated digital dental cast or intraoral scan may be a promising radiation-free method for orthodontic diagnostics and treatment planning. However, due to the inconsistency in different registration methods and small sample sizes, the accuracy is yet to be further investigated.</p><p><strong>Clinical trials registration: </strong>INPLASY (INPLASY202420038).</p>","PeriodicalId":11989,"journal":{"name":"European journal of orthodontics","volume":"48 5","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13445612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of automated algorithm-based versus manual dental landmark placement for model analysis and evaluation of orthodontic quality indices.","authors":"Norbert Alexander Lang, Franziska Alina Lang, Christian Niederau, Anne Schieberle, Kay Stankov, Michael Wolf, Rogerio Bastos Craveiro","doi":"10.1093/ejo/cjag063","DOIUrl":"10.1093/ejo/cjag063","url":null,"abstract":"<p><strong>Background: </strong>Digital approaches have fundamentally transformed orthodontics. This study compares an automated, rule-based algorithm with manual landmark placement, evaluating the results of manual versus semi-automated orthodontic quality indices.</p><p><strong>Methodology: </strong>This retrospective method-comparison study evaluated 100 digital models from 50 orthodontic patients using the Onyxceph3™ diagnostic software. Primary automated landmark placement was assessed for four predefined dental landmark types across 14 tooth groups and was then compared with expert-based manual landmark placement, which was used as the reference standard. Deviations were quantified using Euclidean distances and signed coordinate differences along the X-, Y- and Z-axes. Secondly, we evaluated semi-automated versus manual orthodontic quality assessment using the ABO eCRE and PAR index.</p><p><strong>Results: </strong>Cusps and incisal landmarks show low levels of error when using automatic placement compared with manual placement, with a threshold of ≤1 mm. Vestibular marginal gingival landmarks show the highest deviation. Across tooth groups, mean deviations ranged from 0.54 mm for second molars (95% CI 0.49-0.59) to 0.83 mm for canines (95% CI 0.80-0.85). There was no relevant global directional bias in the X-, Y- and Z-axes. Secondary analysis revealed mean differences of 1.90 points and 3.98 points for ABO eCRE, and -0.08 points and 0.74 for PAR in initial and final models, respectively.</p><p><strong>Conclusion: </strong>The automatic placement of landmarks generally showed acceptable deviations, with the exception of vestibular marginal gingival landmarks. However, the automatic detection of landmarks and orthodontic indices should always be reviewed by a clinician.</p>","PeriodicalId":11989,"journal":{"name":"European journal of orthodontics","volume":"48 5","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13507319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Osteoclast-specific HIF-1α regulates hypoxia-associated bone remodeling during orthodontic tooth movement.","authors":"Qian Zhang, Yi Tang, Miaomiao Bie, Tairan Wang, Yuxing Xia, Yangyifan Zhou, Rong Cong, Chaoqun Pan, Feiwu Kang","doi":"10.1093/ejo/cjag062","DOIUrl":"https://doi.org/10.1093/ejo/cjag062","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the role of osteoclast-specific HIF-1α in orthodontic tooth movement and to explore the underlying molecular mechanisms.</p><p><strong>Methods: </strong>A controlled experimental study was performed using a murine OTM model and osteoclast-specific HIF-1α conditional knockout mice (HIF-1αfl/fl; Ctsk-Cre). In vitro osteoclast differentiation assays were conducted using RAW264.7 cells under hypoxic or hypoxia-mimetic conditions. Tooth movement distance and trabecular bone parameters were assessed by micro-computed tomography. Histological staining (H&E and TRAP), immunofluorescence, quantitative PCR and Western blotting were used to evaluate osteoclast number and the expression of HIF-1α and transferrin receptor (TFRC). Small interfering RNA was used to examine the functional role of TFRC.</p><p><strong>Results: </strong>Osteoclast activity increased during OTM and was associated with reduced local oxygen levels and HIF-1α stabilization. Osteoclast-specific deletion of HIF-1α reduced tooth movement distance, decreased osteoclast numbers and increased trabecular bone volume. HIF-1α upregulated TFRC expression under hypoxic conditions, and TFRC silencing attenuated osteoclast differentiation. Pharmacological stabilization of HIF-1α enhanced tooth movement in wild-type mice.</p><p><strong>Conclusions: </strong>Osteoclast-intrinsic HIF-1α contributes to force-induced bone remodeling and promotes osteoclast differentiation n through a TFRC-associated pathway. Modulation of hypoxia-responsive mechanisms may provide a potential approach to influence orthodontic treatment outcomes.</p>","PeriodicalId":11989,"journal":{"name":"European journal of orthodontics","volume":"48 5","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of the accuracy of automated tooth segmentation using different orthodontic platforms and models with a large-scale clinical applicability.","authors":"Serena Moschitto, Maria Giovanna Pantalena, Umberto Gulisano, Giuseppe Palazzo, Antonino Lo Giudice","doi":"10.1093/ejo/cjag029","DOIUrl":"10.1093/ejo/cjag029","url":null,"abstract":"<p><strong>Background/objectives: </strong>Tooth segmentation remains the most time-consuming task during model preparation for digital orthodontic setup. This study aimed to assess the accuracy of AI-based tooth segmentation tools of four widely used orthodontic platforms, namely Medit LINK (©Medit Corp, South Korea), DentOne (©DIORCO Co, South Korea), BlueSkyPlan (Blu Sky Bio, USA), and ArchForm, using models categorized by specific clinical characteristics.</p><p><strong>Materials/methods: </strong>A total of 270 digital dental models were retrospectively selected and assigned to nine groups: aligned dentition, crowding, spacing, ectopia, agenesis, gingival recession, tooth wear, orthodontic brackets, and attachments. Automated labeling success and segmentation quality were evaluated for each software. Mesio-distal (MD) tooth widths were calculated using Meshmixer software (Autodesk, San Rafael, Calif) and compared with unsegmented models (ground truth). All data were statistically analyzed.</p><p><strong>Results: </strong>BlueSkyPlan consistently outperformed the other tested software in tooth labeling, surface segmentation, and mesio-distal measurements accuracy across all model groups (P < 0.05). Labeling errors were most frequent in models with ectopic teeth (≤12.2% success) and agenesis (≤53.1% success). Surface-specific errors increased with crowding (buccal/lingual errors), spacing (mesio-distal errors), gingival recession (buccal errors), and tooth wear (occlusal errors). All software overestimated MD widths compared with ground truth with the limits of agreement considered clinically relevant (>0.30 mm) in specific software-model combinations).</p><p><strong>Limitations: </strong>The software evaluated does not provide transparency regarding the AI technologies implemented.</p><p><strong>Conclusions/implications: </strong>The accuracy of automatic segmentation of intra-oral scans is influenced by clinical and anatomical characteristics of the dental arches and still requires clinician supervision. BlueSkyPlan currently appears to provide the most reliable performance among the tested platforms.</p>","PeriodicalId":11989,"journal":{"name":"European journal of orthodontics","volume":"48 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148148619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Powered vs. manual toothbrushes in fixed orthodontic patients: a systematic review and meta-analysis.","authors":"Yinli Liu, Fawn Nitanee Van der Weijden, Nadine Jaquet, Godefridus August Van der Weijden, Dagmar Else Slot","doi":"10.1093/ejo/cjag026","DOIUrl":"10.1093/ejo/cjag026","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The benefits of powered toothbrushes (PTBs) over manual toothbrushes (MTBs) are well established. However, for orthodontic patients with fixed appliances (FAs), the evidence remains diverging. Moreover, direct comparisons between PTBs with different action modes and MTBs in terms of plaque and gingivitis control are limited. With new data emerging, an updated synthesis of the literature, including subgroup analysis by PTB action mode, is warranted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To determine the efficacy of PTBs vs. MTBs in orthodontic patients with FAs on reducing plaque scores (PS), gingivitis scores (GS) and gingival bleeding scores (BS).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;PubMed-MEDLINE and Cochrane-CENTRAL were searched until November 2025, and the reference lists of eligible studies were manually reviewed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;Controlled clinical trials (CCTs) or randomized controlled clinical trials (RCTs); involving orthodontic patients with buccal FAs, toothbrushing performed by participants in good general health; comparing PTBs and MTBs; reporting PS, GS, and BS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;From the included papers, data of interest were extracted, risk of bias was evaluated by RoB 2 or ROBINS-I, and a descriptive analysis was performed. Where possible, meta-analyses were performed with subgroup meta-analyses by evaluation index or/and PTB action mode, along with heterogeneity evaluation, publication bias assessment, sensitivity analysis and trial sequential analysis. The evidence quality and effect sizes were assessed, and, where appropriate, the strength of recommendations was rated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Twenty-three papers (including 39 comparisons) were eligible, with low-to-high risk of bias and considerable heterogeneity. Descriptive analysis found no overall difference in most comparisons for PS (64%), GS (76%), and BS (75%). Incremental-difference meta-analyses indicated PTBs had medium effects over MTBs on PS [standardized mean difference (SMD) = -0.77, 95% confidence interval (CI): -1.33 to -0.21, P = .007, I2 = 92%], large effects on GS (SMD = -0.82, 95% CI: -1.55 to -0.09, P = .03, I2 = 93%), and medium effects on BS (SMD = -0.51, 95% CI: -0.88 to -0.13, P = .008, I2 = 80%). All sensitivity analyses confirmed PTB benefits for BS, with RCT-restricted analyses supporting improvements for PS and GS. Publication bias could not be excluded for any incremental-difference meta-analyses, and evidence quality was low across all parameters. In subgroup meta-analyses by PTB action mode, counter-rotational PTBs (CR-PTBs) showed large effects on PS (very low-quality evidence).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;For fixed orthodontic patients, low-quality evidence limited by methodological weaknesses and inconsistency suggests PTBs may moderately improve PS compared with MTBs, with medium to large effects on gingival parameters. Subanalysis ","PeriodicalId":11989,"journal":{"name":"European journal of orthodontics","volume":"48 4","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13256007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148224048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}