European journal of orthodontics最新文献

{"title":"Non-surgical treatment of skeletal Class II malocclusion in children and adolescents: an umbrella review.","authors":"Mayuri Mundhe, Abhisek Bhattacharjee, Nitesh Tewari, Richa Khanna, Rajeev Kumar Singh","doi":"10.1093/ejo/cjaf109","DOIUrl":"10.1093/ejo/cjaf109","url":null,"abstract":"<p><strong>Background: </strong>Class II malocclusion is primarily caused by mandibular retrusion and has significant functional, aesthetic, and psychological implications. Although there are many non-surgical treatment options available, their actual skeletal effects are still mild, varied, and not always reported. Clear conclusions have been limited by overlapping data and variable quality, despite these interventions being the subject of numerous systematic reviews (SRs).</p><p><strong>Objectives: </strong>To synthesize and critically appraise evidence from published SRs of the efficacy of orthodontic and dentofacial orthopaedic interventions for skeletal Class II malocclusion.</p><p><strong>Search methods: </strong>PubMed, Scopus, Embase and Google Scholar were systematically searched till May 2025. A manual citation search was also performed.</p><p><strong>Selection criteria: </strong>SRs involving children or adolescents with clinically and/or radiographically confirmed sagittal skeletal discrepancies, assessing non-surgical interventions against any comparator, and evaluating outcomes including skeletal changes, patient-reported measures, or operator-related measures, using qualitative, quantitative, or mixed synthesis, without restrictions on language or publication year, were included.</p><p><strong>Data collection and analysis: </strong>Two independent reviewers selected the included reviews, initially by screening titles and abstracts, and then by reading the full texts. Methodological quality was evaluated using the AMSTAR-2, and the risk of bias was assessed using the ROBIS. Overlap of primary studies was quantified using the GROOVE tool. When second-order meta-analysis (meta-meta-analysis or MMA) was feasible, random-effects models were used; otherwise, narrative synthesis was performed. The certainty of evidence was rated using the GRADE method.</p><p><strong>Results: </strong>Twenty-eight SRs were included. The most consistent skeletal improvements, particularly in ANB and SNB angles and mandibular length, were shown by removable functional appliances (RFAs), especially the Twin Block. Fixed functional appliances produced favourable but more variable effects, while headgear reduced maxillary growth but was compliance-dependent. Incremental mandibular advancement offered little advantage over single-step protocols, and no clear benefit was observed for early versus late treatment. Considerable heterogeneity and overlap across reviews limit confidence in pooled estimates.</p><p><strong>Conclusions: </strong>RFAs show the most consistent direction of skeletal improvement, although the magnitude of change is modest and the certainty of evidence is predominantly low. Findings for other approaches remain inconsistent and methodologically limited. Future research must incorporate standardized protocols, age-stratified outcomes, and patient-centred measures through rigorously designed randomized controlled trials to strengthen clinical gu","PeriodicalId":11989,"journal":{"name":"European journal of orthodontics","volume":"48 3","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927811","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":"Dento-skeletal effect of maxillary expansion appliances in growing children and adolescents with transverse deficiency: a network meta-analysis.","authors":"Nitesh Malik, Sanjeev Verma, Vinay Kumar, Raj Kumar Verma, Satinder Pal Singh, Ashok Kumar","doi":"10.1093/ejo/cjag027","DOIUrl":"10.1093/ejo/cjag027","url":null,"abstract":"<p><strong>Objectives: </strong>To quantitatively analyze the dentoskeletal effect of various maxillary expansion appliances on growing children and adolescents with transverse maxillary arch deficiency three-dimensionally and to establish the direct and indirect relationship of various maxillary expansion appliances.</p><p><strong>Materials and methods: </strong>A comprehensive electronic literature search was conducted through 31 March 2025, using major health science databases. Studies that fulfilled the PICOS inclusion criteria were included. The ROBINS-I and the Cochrane RoB 2 tool was used for the quality assessment of non-randomized and randomized studies, respectively. A random-effects inverse-variance meta-analysis was used to pool the results. Outcome variables assessed were inter-molar width (IMW), maxillary width (MW), nasal width (NW), buccolingual tipping, and alveolar bone thickness. Subgroup analyses were performed by age and study design. Confidence ratings were given using CINeMA.</p><p><strong>Results: </strong>For dento-skeletal changes, Hybrid Hyrax and MARPE produced significantly higher increases in NW [mean difference, MD: 0.80 (95% confidence interval, CI: 0.43; 1.17); P < .0001 and MD: 0.83 (95% CI: 0.45; 1.20); P < .0001], respectively, whereas Leaf Expander showed significantly smaller increase in NW [MD: -1.24; (95% CI: -2.08; -0.040); P = .0037]. Hybrid Hyrax and MARPE had the highest probability of being ranked first, and Leaf Expander the last. For the effect on the periodontium, Quad Helix was least desirable, producing the greatest buccolingual tipping MD: 1.40 (95% CI: 0.50; 2.30); P = .002].</p><p><strong>Conclusion: </strong>Due to low to moderate level of evidence, findings of the network analysis should be interpreted with caution. The network meta-analysis showed that all appliances increased IMW, MW, without significant differences. MARPE and Hybrid Hyrax were more effective in expanding the nasal cavity width. The Quad Helix showed increased buccolingual tipping with reduced buccal bone thickness and increased palatal bone thickness compared with others. Further high-quality studies are required to obtain more robust results.</p>","PeriodicalId":11989,"journal":{"name":"European journal of orthodontics","volume":"48 3","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147971573","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":"Impact of clear aligners and conventional fixed orthodontic appliances on oral hygiene and periodontal health: A systematic review with GRADE assessment of the certainty of evidence.","authors":"Malak A Alhuwaizi, Hayder F Saloom, Martyn Cobourne","doi":"10.1093/ejo/cjaf100","DOIUrl":"10.1093/ejo/cjaf100","url":null,"abstract":"<p><strong>Background: </strong>The use of clear aligners (CA) has exponentially increased in the last decades due to their superior esthetic, ease of use and cleaning, and comfort in comparison to conventional fixed appliance (FA). However, prolonged wearing of CA could also alter oral microbiome and adversely affect oral hygiene and periodontal health.</p><p><strong>Objective: </strong>To assess oral hygiene level and periodontal health status in patients treated with CA versus those treated with FA using a combination of risk of bias (RoB) and Grading of Recommendations Assessment, Development and Evaluation (GRADE) tools.</p><p><strong>Search methods: </strong>A comprehensive electronic search was conducted in four databases, including Scopus, PubMed, Web of Science, and Google Scholar, to retrieve relevant randomized controlled trials (RCTs) in the last 10 years from 2015 to April 2025.</p><p><strong>Selection criteria: </strong>The study aimed to include RCTs that focused on the impact of CA and FA orthodontic treatments on oral hygiene and periodontal health.</p><p><strong>Data collection and analysis: </strong>Independent eligibility assessment, data extraction, and filtering process were performed. The RoB 2 tool was used to assess the quality of the included RCTs. Data relating to oral hygiene/periodontal health assessed by different clinical periodontal indices (primary outcome) and other findings (secondary outcomes) were extracted. Certainty of evidence was determined using GRADE system.</p><p><strong>Results: </strong>Initial search process yielded 1098 records which were assessed for eligibility, screened according to titles, abstracts, and full-text reading. Six RCTs were found eligible for analysis and included for synthesis of evidence. Qualitative analyses of the included RCTs showed that periodontal parameters were significantly better in patients treated with CA than with FA. Five RCTs exhibited high RoB together with overall inconsistencies in the given oral hygiene instructions, age, follow-up, diagnosis, and measurements. Certainty of evidence ranged from very low for oral hygiene level and low for periodontal health.</p><p><strong>Conclusions: </strong>Dual quality assessment indicated that the advantages of CA over FA in terms of oral hygiene and periodontal health are highly compliance dependent. However, due to heterogeneities, high RoB, and low to very low certainty of evidence in current RCTs, outlining a firm conclusion was impeded.</p><p><strong>Registration: </strong>PROSPERO (CRD420251120933).</p>","PeriodicalId":11989,"journal":{"name":"European journal of orthodontics","volume":"48 3","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147981138","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":"Practice of lingual orthodontics among specialist orthodontists in France: a national survey study.","authors":"Marc-Antoine Pécourt, Bart Vande Vannet, Paul Fawaz","doi":"10.1093/ejo/cjag038","DOIUrl":"10.1093/ejo/cjag038","url":null,"abstract":"<p><strong>Objective: </strong>To characterize current lingual orthodontic (LO) practice among orthodontists in France, assess how the emergence of clear aligner (CA) therapy has influenced its clinical use and document clinicians' perspectives on the future of LO.</p><p><strong>Methods: </strong>A survey using a 39-item questionnaire was administered via the SurveyMonkey® platform. The survey was distributed through the French Syndicate of Specialists in Orthodontics (SFSO), the Syndicate of Orthodontists of France (Les ODF), and a professional Facebook group, reaching an estimated 2971 orthodontists. Responses were collected anonymously. Data were analyzed using Python v3.12.7 with univariate and bivariate statistics; associations were assessed using χ2 and Spearman correlation tests, with significance set at α = 0.05.</p><p><strong>Results: </strong>Of 201 respondents, 59.7% (n = 120) reported active practice of LO. The most frequently used systems were WIN® (43.9%) and Incognito® (36.7%). A majority of practitioners treated 1-10 lingual cases annually, whereas aligner therapy was reported more frequently, with 28.3% indicating 21-50 aligner cases per year. Nearly half (48.4%, n = 46 of 95 respondents) reported offering lingual treatment less often since the rise in aligner use, and 76.8% (n = 73 of 95 respondents) perceived a decrease in patient demand for lingual appliances. Major reported barriers to lingual practice included prolonged chairside time (28.5%), limited clinician training (23.5%), and low patient demand (22.3%). Despite these challenges, 92.3% of respondents reported satisfaction with their clinical outcomes. Following the discontinuation of the Incognito® system, 28.6% of users planned to discontinue LO, and 80% expressed intent to transition to aligner therapy.</p><p><strong>Conclusions: </strong>Although a majority of the respondents report experience with LO, it represents a minority of their annual caseload. The increasing use of CAs appears to have influenced reported practice patterns. However, these findings reflect practitioner-reported behaviors and perceptions rather than clinical indications or appropriateness. LO is still perceived by clinicians as offering advantages in predictability, efficacy, and esthetic discretion, suggesting it may continue to play a role for select patients in contemporary orthodontic practice.</p>","PeriodicalId":11989,"journal":{"name":"European journal of orthodontics","volume":"48 3","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147981061","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":"Evaluation of imaging protocols for detecting tooth ankylosis using different CBCT devices: an in vitro study.","authors":"Şelale Özel, Taha Emre Köse, Samed Şatır","doi":"10.1093/ejo/cjag043","DOIUrl":"10.1093/ejo/cjag043","url":null,"abstract":"<p><strong>Background: </strong>To compare the diagnostic accuracy of CBCT images acquired with different imaging protocols for detecting tooth ankylosis.</p><p><strong>Methods: </strong>Thirty extracted permanent teeth (20 single-rooted, 10 three-rooted) were prepared; ankylosis was simulated in 20 by selectively removing Teflon from roots previously coated to mimic the periodontal ligament. Samples were embedded in stone plaster and imaged using 4 protocols on 2 CBCT units. CBCT images were primarily evaluated by a blinded radiologist (present/absent). Micro-CT was performed on 20% of specimens to verify the model. Agreement and accuracy metrics (Fleiss/Cohen κ, sensitivity, specificity, PPV, NPV) were calculated.</p><p><strong>Results: </strong>Protocol 2 (0.25 mm voxel) showed the most favorable performance (κ = 0.113; sensitivity 71.4%; PPV 52.6%; NPV 60%). Protocol 3 (0.35 mm voxel) performed worst (κ = -0.104; sensitivity 53.8%; PPV 43.8%; NPV 45.5%). Except for Protocol 3, sensitivity was high (≥71.4%) while specificity remained low (35.7%-42.9%).</p><p><strong>Limitations: </strong>The study has its own limits. Different imaging protocols using in clinical practice to detect ankylosis can be investigated as well to provide different approaches assessing ankylosis.</p><p><strong>Conclusion: </strong>CBCT demonstrated high sensitivity but low specificity for ankylosis detection, indicating a propensity for false positives. Smaller voxel sizes (0.25-0.30 mm) improved detection, whereas 0.35 mm was least reliable.</p>","PeriodicalId":11989,"journal":{"name":"European journal of orthodontics","volume":"48 3","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148005033","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":"Differential salivary proteome of nonsyndromic cleft lip and/or palate patients with and without dental caries in comparison with nonaffected individuals.","authors":"Maria Cadenas de Llano-Pérula, Marie De Laet, Zuodong Zhao, Guy Willems, Christine Vergalle, Greet Hens, Anna Verdonck","doi":"10.1093/ejo/cjag044","DOIUrl":"10.1093/ejo/cjag044","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the salivary proteome between nonsyndromic cleft lip and/or palate (nsCL/P) patients and nonaffected individuals using a cross-sectional study design, and exploring the influence of age, sex, caries and cleft type on the salivary proteome.</p><p><strong>Methods: </strong>Stimulated saliva samples were collected from 184 patients. Subjects with DMFT/dmft (sum of decayed/missing/filled teeth in both the permanent and deciduous dentition) ≥ 5 were classified as 'with caries'. Proteins were semi-quantified by mass spectrometry and analysed with Partial Least Square (PLS) in 101 patients (77 nsCL/P: 28 nsCP, 36 unilateral nsC/LP (nsUCLP), 13 bilateral nsC/LP (nsBCLP); and 24 controls), two-way ANOVA and post-hoc Fisher's tests. The contribution of caries, sex, age and cleft type to the proteome, including interaction between cleft type and caries were examined. Validation by PCA were conducted on 49 samples from validation sets.</p><p><strong>Results: </strong>Salivary proteomic differed significantly between nsCL/P and controls, as well as between cleft types. Protein abundance correlated strongly with age, followed by cleft type and sex, and weakly with caries. Across cleft types, the presence of caries was associated with consistently lower salivary protein abundance compared with noncaries groups, especially in nsBCLP. In total 35 proteins differed between patients with and without cleft, of which 19 proteins were consistently identified in both training and validation dataset.</p><p><strong>Conclusions: </strong>The salivary proteome differs among nsCP, nsUCLP, nsBCLP and nonaffected subjects and is correlated with age, sex, cleft presence and cleft type, but weakly with caries. These differences may be clinically relevant for identifying oral health vulnerability in patients with nsCL/P and supporting personalized preventive strategies.</p>","PeriodicalId":11989,"journal":{"name":"European journal of orthodontics","volume":"48 3","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148028469","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":"Exploring LLM-based chatbot effectiveness in answering questions related to the risks and benefits of orthognathic treatment: a cross-sectional study.","authors":"Robert Samuel David Smyth, Aliki Tsichlaki","doi":"10.1093/ejo/cjag034","DOIUrl":"10.1093/ejo/cjag034","url":null,"abstract":"<p><strong>Objective: </strong>To assess the accuracy, reliability, quality, and readability of responses generated by three large language model chatbots, ChatGPT4o, Microsoft Copilot, and Google Gemini 2.5 Flash, when answering common patient questions about the risks and benefits of orthognathic treatment.</p><p><strong>Materials and methods: </strong>Twenty frequently searched questions were identified via Google and entered into each chatbot. Responses were evaluated using validated scoring systems for accuracy, modified DISCERN, global quality scale (GQS), and Flesch Reading Ease. Intra- and inter-rater reliability was assessed using Cohen's kappa and intra-class correlation coefficients. Non-parametric tests were applied due to non-normal data distribution.</p><p><strong>Results: </strong>Copilot achieved the highest reliability and quality scores, with significant differences observed in modified DISCERN (P < 0.001) and GQS (P = 0.046). Post hoc tests confirmed Copilot significantly outperformed ChatGPT. Accuracy scores did not differ significantly (P = 0.704). Readability varied significantly with Gemini and ChatGPT producing more accessible responses than Copilot. Intra- and inter-rater reliability scores were substantial to excellent for categorical measures and excellent for readability.</p><p><strong>Conclusions: </strong>Copilot provided the most reliable and high-quality responses, whilst ChatGPT and Gemini offered greater readability ease. Despite these strengths, variability in accuracy and reliability highlights the need for caution. Chatbots should be considered as supplementary tools, and patients should verify information with qualified professionals.</p>","PeriodicalId":11989,"journal":{"name":"European journal of orthodontics","volume":"48 3","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13168883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927817","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":"Impact of oral probiotics on oral health and halitosis in orthodontic patients treated with aligners or conventional fixed appliances vs placebo: two randomized clinical trials.","authors":"Georgios Vasoglou, Ioulia-Maria Mylonopoulou, Gerassimos Angelopoulos, Dimitrios Kloukos, Nikolaos Pandis, Iosif Sifakakis","doi":"10.1093/ejo/cjag028","DOIUrl":"10.1093/ejo/cjag028","url":null,"abstract":"<p><strong>Background: </strong>Halitosis is primarily caused by oral microbiota dysbiosis, exacerbated by orthodontic appliances that promote plaque retention. Probiotics offer a potential non-invasive strategy to rebalance oral flora and reduce volatile sulfur compounds (VSCs), but their clinical effectiveness remains largely underexplored in Orthodontics.</p><p><strong>Objectives: </strong>The aim of these trials was to determine the effect of oral probiotics containing Lactobacillus salivarius Oral S1 on plaque and gingival indices as well as on halitosis (via VSC) in patients treated with orthodontic brackets or aligners vs placebo.</p><p><strong>Methods: </strong>This study was ran as two separate parallel 2-arm trials (fixed appliance trial and aligner trial) in two centers. Each trial included 59 patients randomly allocated to either probiotics or placebo. The intervention was 1 month course of probiotics, compared with placebo. The primary outcome was the modified plaque index (PI-M) and the secondary outcomes were the gingival index (GI) and the VSC levels i.e. H2S, CH3SH, (CH3)2S and their sum (total VSC), all measured at baseline (T0), after 1 month of intervention (T1), and 2 months after discontinuation of the probiotics (T2).</p><p><strong>Results: </strong>In the aligner group, a significant treatment × time interaction was detected for H2S (P < .001) and total VSC (P < .001), indicating that the changes in these variables over time differed significantly between the treatment groups. In the fixed appliance group, a statistically significant treatment × time interaction was identified for PI-M (P = .01), GI (P < .001), H2S (P = .03), and total VSC (P = .03). Probiotic use was particularly effective in the latter group, with notable improvements in plaque control, gingival health, and halitosis reduction. Partial relapse occurred by T2, suggesting that benefits mostly diminish after intervention cessation.</p><p><strong>Conclusions: </strong>Administration of oral probiotics for 1 month significantly improved periodontal health and reduced halitosis in orthodontic patients, especially in those with fixed appliances.</p>","PeriodicalId":11989,"journal":{"name":"European journal of orthodontics","volume":"48 3","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927849","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":"Physical, mechanical properties and accuracy of thermoformed vs 3D-printed aligners: systematic review and meta-analysis.","authors":"Jader O Jorge, Beatriz R Bergo, Carina C Montalvany-Antonucci, Natália C Figueiredo, Ildeu Andrade, Lucas G Abreu, Soraia Macari","doi":"10.1093/ejo/cjag036","DOIUrl":"10.1093/ejo/cjag036","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Esthetic orthodontic aligners are removable polymer-based devices fabricated via thermoforming (TM) or direct three-dimensional printing (DTP). However, a gap remains in the literature regarding how these two manufacturing methods differ in their mechanical and physical properties.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This systematic review aimed to assess and compare changes in the physical and mechanical properties of orthodontic aligners fabricated by TM or DTP methods. However, it should be noted that the included evidence does not allow a clear separation between manufacturing method and material system, as TM and DTP aligners were based on fundamentally different polymer.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;A systematic search was conducted in six electronic databases in May 2025. Selection criteria: In vitro studies comparing these properties between TM and DTP aligners were included. Data collection and analysis: Two reviewers independently selected studies, extracted data, and performed risk-of-bias assessments and meta-analyses. Twenty-three studies were selected, and four were included in the meta-analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;TM and DTP aligners exhibited distinct mechanical patterns. TM aligners generally showed higher flexural strength, storage modulus stability, and surface microhardness, reflecting greater initial rigidity. In contrast, DTP aligners demonstrated higher shape recovery potential, greater traction forces in vertical tests, and improved geometric accuracy under laboratory conditions. Regarding physical characteristics, TM aligners exhibited an average thickness reduction of -39.76% after fabrication, color change, and lower ultraviolet stability; while geometric accuracy tended to favor DTP aligners with a thickness increase of +11.02%, and better marginal adaptation. DTP aligners also exhibited a lower glass transition temperature (Tg = 42.3°C), suggesting differences in thermomechanical response. The meta-analysis showed that surface roughness assessments revealed higher Sa (mean surface amplitude) values in DTP aligners, whereas TM aligners exhibited greater Sv (valley depth). Following clinical use, DTP aligners maintained higher Sz (total amplitude) values, while TM aligners demonstrated reduced Sa values. There was no statistically significant difference in thickness variation between the two fabrication methods (standardized mean difference = 1.48; 95% confidence interval: -7.26-4.30; P = .62), with high heterogeneity (I2 = 97%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;TM and DTP aligners show distinct physical and mechanical behaviors influenced by manufacturing and material characteristics. As current evidence is limited to in vitro studies, further clinical research is needed to confirm these findings and their relevance in patient care. Therefore, any clinical extrapolation should be taken with caution and interpreted within the limitations of the current evidence bas","PeriodicalId":11989,"journal":{"name":"European journal of orthodontics","volume":"48 3","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147962603","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":"Validity of digital manual and automated 2D structural superimposition on the anterior cranial base.","authors":"Dimitrios Vasileiou, Konstantina Tsironi, Dimitrios Konstantonis, Demetrios Halazonetis","doi":"10.1093/ejo/cjag008","DOIUrl":"10.1093/ejo/cjag008","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the validity of digital manual and automated structural superimposition on the anterior cranial base using Björk's two-dimensional (2D) cephalometric method. Secondary aims included assessing repeatability and reproducibility, comparing manual and automated methods, and testing a color blending superimposition mode.</p><p><strong>Materials and methods: </strong>Fourteen dry human skulls were radiographed twice. A gold standard superimposition was established using metallic markers. Three observers performed digital manual superimpositions twice on each skull; once using grayscale images and once using a color blending mode. Superimpositions were repeated one week later. An automated mutual information-based superimposition was also performed. Validity was assessed using root mean square error (RMSE) at 14 standardized cephalometric landmarks from a reference template. The RMSE of the automated method was compared with the average RMSE of each examiner across both trials using General Linear Models. Alignment time was recorded for the manual methods.</p><p><strong>Results: </strong>The automated method demonstrated high validity (RMSE 0.48 mm, SD 0.35), closely matching the performance of the most accurate observer (RMSE 0.38 mm, SD 0.22), and showed no statistically significant difference when compared with the digital manual methods. A statistically significant difference in accuracy was observed between the observers (F = 4.76, P = 0.017). Color blending did not improve accuracy, but significantly reduced alignment time for two observers. No significant differences were found between repeats (P > 0.5).</p><p><strong>Conclusions: </strong>The digital manual and automated methods showed comparable validity. While color blending did not improve accuracy, it may reduce alignment time for some clinicians. Both approaches appear reliable and efficient.</p>","PeriodicalId":11989,"journal":{"name":"European journal of orthodontics","volume":"48 3","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148028553","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}