Orthodontics & Craniofacial Research最新文献

{"title":"Patient Harm From Orthodontic Care (Part III): The Care Provider Perspective and the Second Victim Phenomenon.","authors":"Kristine Læssøe-Arendt, Nikolaos Ferlias, Julian Woolley, Peter Stoustrup","doi":"10.1111/ocr.70195","DOIUrl":"https://doi.org/10.1111/ocr.70195","url":null,"abstract":"<p><strong>Background: </strong>Understanding the psychological and professional consequences of patient harm events is crucial for improving clinical practice and support systems.</p><p><strong>Aim: </strong>(1) To investigate the prevalence of self-reported patient harm events involving orthodontic professionals, (2) to assess the psychological, physical, and professional impact of these events, and (3) to identify aspects of importance to mitigate the psychological and physical impact among orthodontic care providers involved in patient harm events.</p><p><strong>Materials & methods: </strong>An online questionnaire-based survey was conducted among orthodontic care providers, including orthodontists, dentists, hygienists, and dental assistants during two orthodontic conferences in Denmark. The questionnaire assessed respondents' experience with patient harm events, types of harm, the psychological and physical impact of being involved, and their working environment.</p><p><strong>Results: </strong>A total of 297 participants completed the survey, in which 45.9% (n = 135) reported involvement in a patient harm event and 20.8% (n = 61) experienced an event within the past year. Following a harmful event, significant psychological distress was reported by 49.2% (n = 87) of professionals, while 21.5% (n = 38) experienced physical symptoms and 8.8% (n = 16) considered leaving their job. A fear of causing harm was also evident, with 32.4% (n = 95) participants experiencing high to very high levels of psychological stress. Orthodontists reported greater stress related to the risk of causing harm compared to other orthodontic team members (p = 0.001). Orthodontists involved in a patient harm event also reported greater psychological (p = 0.002) and physical impact (p = 0.001) than other clinical staff members. No significant differences were found based on age, gender or years of clinical experience. Respondents most frequently identified structured organizational support, supportive leadership, and peer support as key measures to mitigate the impact of patient harm events.</p><p><strong>Conclusion: </strong>Patient harm events may affect orthodontists and staff and potentially cause significant psychological and physical impact, emphasizing the need for structured support and peer programmes to enhance provider well-being and patient safety.</p>","PeriodicalId":19652,"journal":{"name":"Orthodontics & Craniofacial Research","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168285","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":"Regulatory Effects of Bone Morphogenetic Protein-4 on Tumour Necrosis Factor-Alpha-Induced IL-6 and M-CSF Expression in Cementoblasts.","authors":"Yunlong Wang, Zhengguo Cao, Hong He, Zhijian Liu","doi":"10.1111/ocr.70193","DOIUrl":"https://doi.org/10.1111/ocr.70193","url":null,"abstract":"<p><strong>Objective: </strong>Orthodontically induced root resorption involves the destruction of cementum, and in severe cases, dentine. Cementoblasts are cells responsible for depositing and mineralizing cementum, and they can also communicate with osteoclasts to indirectly regulate cementum destruction. This study aimed to elucidate the impact of TNF-α on IL-6 and M-CSF, two potent osteoclast-activating cytokines secreted by cementoblasts. Additionally, the study explored the combined effects of BMP-2, BMP-4, BMP-6, BMP-7 and TNF-α.</p><p><strong>Materials and methods: </strong>We utilized the immortalized mouse cementoblast cell line OCCM-30. Cells were incubated with TNF-α, followed by RT-qPCR and ELISA to assess IL-6 and M-CSF expression. Prior to TNF-α stimulation, cells were pre-incubated with inhibitors targeting p38 MAPK, Erk1/2, JNK, PI3K-Akt, or NF-κB pathways, and IL-6 and M-CSF levels were analysed by RT-qPCR. Cells were also treated with combinations of BMP-2, BMP-4, BMP-6, BMP-7 and TNF-α, and their synergistic effects on IL-6 and M-CSF were evaluated by RT-qPCR and ELISA.</p><p><strong>Results: </strong>TNF-α significantly increased both IL-6 and M-CSF mRNA levels, as well as their secreted levels. Blocking the NF-κB pathway partially reversed TNF-α-induced upregulation of IL-6 and M-CSF. BMP-4 and BMP-2 further potentiated TNF-α-induced upregulation of IL-6 and M-CSF, while BMP-6 and BMP-7 had no effect.</p><p><strong>Conclusion: </strong>TNF-α increased IL-6 and M-CSF expression in cementoblasts via the NF-κB pathway. BMP-4 and BMP-2 exacerbated the TNF-α-induced effect on IL-6 and M-CSF.</p>","PeriodicalId":19652,"journal":{"name":"Orthodontics & Craniofacial Research","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148575","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":"Comparative Effectiveness of Skeletal Versus Fixed Anterior Traction in Growing Patients With Skeletal Class III Malocclusion: A Systematic Review and Meta-Analysis.","authors":"Shi Lili, Xu Bowen, Wang Rui","doi":"10.1111/ocr.70189","DOIUrl":"https://doi.org/10.1111/ocr.70189","url":null,"abstract":"<p><p>To compare the skeletal, dentoalveolar, soft-tissue, and treatment-burden effects of skeletal anterior traction (SAT) versus fixed anterior traction (FAT) in growing patients with skeletal Class III malocclusion. PubMed/MEDLINE, Embase, Scopus, Web of Science, and CENTRAL were searched from inception through 15 May 2021, with citation tracking through 30 June 2021. Randomised and non-randomised comparative studies directly evaluating SAT versus FAT in growing Class III patients were eligible. Two reviewers independently screened records, extracted data, and assessed risk of bias with RoB 2 or ROBINS-I as appropriate; certainty was interpreted with GRADE. Random-effects meta-analysis was used for compatible continuous outcomes. The quantitative dataset comprised six comparative studies. In that dataset, SAT was associated with greater maxillary advancement (MD +1.23, 95% CI 0.88 to 1.57), greater intermaxillary sagittal correction (MD +1.38, 95% CI 1.04 to 1.73), less forward mandibular positional change (MD -0.94, 95% CI -1.38 to -0.49), less clockwise mandibular rotation (MD -1.12, 95% CI -1.79 to -0.45), less maxillary-incisor proclination (MD -3.12, 95% CI -4.05 to -2.18), and improved facial convexity (MD +1.42, 95% CI 0.96 to 1.89). Publication-level reconciliation identified two additional pre-2021 direct comparisons already cited in the manuscript and six direct comparative reports published after the original database-search boundary; these were not retrospectively mixed into the retained pooled estimates without a reproducible re-extraction of the original dataset. The retained pooled dataset suggests that SAT shifts early Class III correction toward a more skeletal and less dentoalveolar pattern, but the exact magnitude of the skeletal advantage is uncertain. RCT-only syntheses published subsequently report only small incremental maxillary effects of skeletal anchorage, while the reduction in maxillary-incisor proclination is more consistent. The pooled estimates in this manuscript should therefore be treated as provisional until a complete multi-database update and re-extraction incorporate all eligible direct comparisons.</p>","PeriodicalId":19652,"journal":{"name":"Orthodontics & Craniofacial Research","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148645","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":"Are Posterior Teeth Overerupted or Is the Mandibular Ramus Shorter? - A CBCT Study of Skeletal Class II Hyperdivergent Patients Compared With Class I.","authors":"Xiaoyu Qin, Zhenyuan Zhang, Ruoxin Du, Yaojuan Qian, Junqiu Wang, Hongtao Jiang, Gang Guo, Weifeng Han, Yan Li, Mingfeng Wang","doi":"10.1111/ocr.70192","DOIUrl":"https://doi.org/10.1111/ocr.70192","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study is to investigate posterior tooth height and mandibular ramus height in skeletal Class II hyperdivergent patients using cone-beam computed tomography (CBCT) and to assess their associations with the hyperdivergent pattern.</p><p><strong>Methods: </strong>CBCT data from 60 adult skeletal Class II hyperdivergent patients and 60 adult Class I average-angle patients were analysed. Vertical measurements of posterior teeth and mandibular ramus heights were performed and compared between the two groups using independent samples t-tests. Pearson correlation analyses were performed separately within each group to assess the relationships between posterior teeth heights and mandibular ramus height.</p><p><strong>Results: </strong>Both ramus and condyle heights in the Class II hyperdivergent group were significantly shorter than those in the Class I average-angle group (p < 0.001). And the vertical heights of maxillary molars (U6-FH: 48.5 ± 2.9 mm; U7-FH: 44.8 ± 3.2 mm) in the Class II hyperdivergent group were significantly shorter than those in the Class I group (U6-FH: 49.8 ± 2.9 mm; U7-FH: 47.2 ± 3.0 mm; p = 0.013 and p < 0.001, respectively). Posterior tooth height showed positive correlations with mandibular ramus height in both groups. Correlations with condylar height were less consistent, particularly for the lower posterior teeth. Stronger correlations were observed for the upper posterior teeth.</p><p><strong>Conclusions: </strong>No evidence of posterior tooth overeruption was observed in skeletal Class II hyperdivergent patients. Instead, a shorter mandibular ramus height was observed in the hyperdivergent group compared with the Class I group. Significant positive correlations were found between posterior tooth height and ramus height. These findings indicate an association between skeletal and dental measurements and do not support the previously hypothesized \"struggle\" dynamic.</p>","PeriodicalId":19652,"journal":{"name":"Orthodontics & Craniofacial Research","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113122","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":"Clinical Crown Length Changes Following Maxillary Molar Distalization: The Role of Three-Dimensional Tooth Movement and Third Molar Position.","authors":"Chae-Won Yun, Seorin Jeong, Sung-Hoon Lim, Sun-Kyoung Yu, Jae Hyun Park","doi":"10.1111/ocr.70194","DOIUrl":"https://doi.org/10.1111/ocr.70194","url":null,"abstract":"<p><strong>Introduction: </strong>Maxillary molar distalization is widely used for space gain and anterior retraction. However, gingival recession may occur around the maxillary second molar following distalization, and the tooth movement factors associated with changes in clinical crown length (CCL) remain unclear. This study investigated the associations of CCL changes with three-dimensional movement of the maxillary second molar and the position of the maxillary third molar.</p><p><strong>Methods: </strong>This retrospective study included 58 maxillary second molars from 30 adult patients who underwent skeletal anchorage-assisted maxillary total arch distalization. CCL changes and three-dimensional tooth movements were evaluated using CBCT and digital intraoral scans obtained before and after treatment. Linear mixed-effects models were used to evaluate the associations between CCL changes and second molar movement. Gingival margin displacement was additionally analysed in relation to second molar vertical displacement. In patients with a third molar (n = 38), the associations between CCL changes and the three-dimensional position of the third molar were evaluated. Third molar status was also evaluated by classifying third molars as missing, impacted, or erupted.</p><p><strong>Results: </strong>The mean CCL change was 0.36 ± 0.70 mm. Greater second molar intrusion was significantly associated with decreased CCL (β = -0.108, p = 0.020), whereas distal and transverse movements were not significantly associated with CCL change. With greater second molar intrusion, the gingival margin also moved in the direction of intrusion, but significantly less than the tooth itself (β = 0.793, p = 0.002). In the third-molar subgroup, greater second molar intrusion remained significantly associated with decreased CCL (β = -0.111, p = 0.022), whereas a more buccally positioned third molar was associated with increased CCL (β = 0.132, p = 0.016). Third molar status and third molar angulation were not significantly associated with CCL change.</p><p><strong>Conclusions: </strong>CCL changes during maxillary molar distalization were associated with second molar intrusion and the buccolingual position of the third molar. Greater second molar intrusion was associated with decreased CCL, whereas a more buccally positioned third molar was associated with increased CCL. These findings suggest that vertical movement of the second molar and the three-dimensional position of the third molar should be considered when planning maxillary molar distalization.</p>","PeriodicalId":19652,"journal":{"name":"Orthodontics & Craniofacial Research","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113132","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":"Jaw Dimensions, Skeletal Maturation, and Salivary Hormones in Adolescents With Normal and Increased Body Mass Index: A Cross-Sectional Study.","authors":"Dimitrios Michelogiannakis, Ibrahim Kassem, Luis Mendez, Atoosa Pahlavani, Abdul Basir Barmak, Apostolos Tsolakis, Evangelos Menenakos, Paul Emile Rossouw","doi":"10.1111/ocr.70191","DOIUrl":"https://doi.org/10.1111/ocr.70191","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate jaw dimensions, skeletal maturation, and salivary hormonal and adipokine levels in adolescents with normal and increased body mass index (BMI).</p><p><strong>Setting and sample population: </strong>This cross-sectional study included 50 adolescents (mean age 13.54 ± 1.39 years), categorized into normal (n = 26) or increased BMI (n = 24) groups.</p><p><strong>Materials and methods: </strong>Pre-treatment lateral cephalograms were analysed for effective maxillary (Co-A) and mandibular (Co-Gn) lengths, and skeletal maturation was assessed via the cervical vertebral maturation (CVM) index. The skeletal maturity index (SMI) was evaluated on hand-wrist radiographs. Unstimulated whole saliva (UWS) samples were analysed using multiplex immunoassays for growth hormone, IGF-1, cortisol, estradiol, testosterone, adiponectin, and resistin. Group comparisons used parametric or non-parametric tests with false discovery rate (FDR) correction. Spearman correlations and multivariable regression models, adjusted for age, sex, and race, were computed.</p><p><strong>Results: </strong>Adolescents with increased BMI had significantly greater effective mandibular length (Co-Gn; mean difference: 8.13 mm; FDR-adjusted p = 0.045). Effective maxillary length showed a similar trend (Co-A; FDR-adjusted p = 0.067). No significant differences were observed in vertical, dental, or soft tissue variables, CVM, or SMI. Salivary cortisol was lower (FDR-adjusted p = 0.003) and resistin was higher (FDR-adjusted p = 0.024) in the increased BMI group. In regression models, UWS adiponectin remained an independent negative predictor of Co-A and Co-Gn (both p = 0.005) after adjusting for covariates.</p><p><strong>Conclusions: </strong>Increased BMI was associated with greater mandibular length in pre-treatment orthodontic adolescents. Salivary adiponectin was negatively associated with jaw dimensions.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT07217756.</p>","PeriodicalId":19652,"journal":{"name":"Orthodontics & Craniofacial Research","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113195","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":"Three-Dimensional Facial Soft Tissue Response to Premolar Extraction: Influence of Vertical Skeletal Change Analysed Using Geometric Morphometrics.","authors":"Kiyoshi Tai, Mo Hyeon Lee, Seiji Lida, Kazuki Nakatsuji, Ayumi Okada, Jae Hyun Park","doi":"10.1111/ocr.70185","DOIUrl":"https://doi.org/10.1111/ocr.70185","url":null,"abstract":"<p><strong>Introduction: </strong>The three-dimensional (3D) facial soft tissue response to premolar extraction remains unclear, particularly in relation to vertical skeletal changes.</p><p><strong>Methods: </strong>Thirty-three adult women who underwent orthodontic treatment with the extraction of four premolars were included. Homologous facial models were generated from facial soft-tissue surface data derived from CBCT images acquired before and after treatment. Principal component analysis (PCA) was performed to characterise variation in facial form using homologous model coordinates. Receiver operating characteristic (ROC) analysis was used to evaluate components nominally associated with pre- and post-treatment configurations within each vertical skeletal subgroup.</p><p><strong>Results: </strong>Each vertical skeletal subgroup included 11 subjects. In the decreased-FMA group, PC5 showed the largest nominal AUC (0.79), followed by PC3 and PC11 (both 0.75), with morphological variation concentrated in the lower facial region. In the increased-FMA group, PC7 and PC12 showed nominal AUCs of 0.76 and 0.73, respectively, and were associated with lateral facial narrowing and facial slimming. No meaningful nominal discrimination was identified in the stable-FMA group. These findings indicated distinct group-level morphological tendencies depending on the direction of vertical skeletal change.</p><p><strong>Conclusions: </strong>Three-dimensional facial soft-tissue changes following premolar extraction showed group-level patterns that appeared to vary according to the direction of vertical skeletal change. Patients with decreased FMA tended to show lower facialreorganisation, whereas patients with increased FMA tended to show lateral facial narrowing and facial slimming. Given the modest subgroup size and multiple nominal ROC comparisons, these findings warrant confirmation in larger cohorts.</p>","PeriodicalId":19652,"journal":{"name":"Orthodontics & Craniofacial Research","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069932","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":"Finite Element Analysis of Maxillary Molar Intrusion Using Temporary Anchorage Devices: A Comparison of Direct and Indirect Force Loading.","authors":"Alex Hung Kuo Chou, You-Sun Lee, Ahmed Shoaib, Nikhillesh Vaiid, Sheila So, Yoon-Ah Kook, Olivier Nicolay","doi":"10.1111/ocr.70188","DOIUrl":"https://doi.org/10.1111/ocr.70188","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate and compare the efficacy of maxillary molar intrusion using the modified C-palatal plate (MCPP) and conventional temporary anchorage devices (TADs) through finite element analysis (FEA).</p><p><strong>Methods: </strong>Three-dimensional models of the maxilla were constructed from computed tomography images of a skull study model. FEA models were developed to simulate two different modalities. In the first modality (M1), the MCPP was evaluated by applying forces from three distinct hook locations: 3 mm coronal to the center of resistance of the first molar (M1-A), at the level of the center of resistance (M1-B), and 5 mm apical to the center of resistance (M1-C). In the second modality (M2), maxillary first molar intrusion was evaluated using TADs with an elastic band directed between buccal and palatal miniscrews contacting the tooth occlusal surface. Tooth displacement and stress distribution were analysed for both modalities.</p><p><strong>Results: </strong>M1-A, distalization of the tooth occurred, accompanied by extrusion. M1-B demonstrated distalization with negligible vertical changes, while M1-C resulted in the least distalization but with intrusion. Comparing M1-C with the TADs, M1-C showed similar intrusion as in M2 with the same magnitude of force but with less Von Mises stress at the root surfaces.</p><p><strong>Conclusion: </strong>FEA revealed that the MCPP is a versatile appliance that allows tooth movement with selective control of extrusion or intrusion. The MCPP with indirect force loading can induce the same intrusive movement of the maxillary molar as TADs with less stress on the root surface.</p>","PeriodicalId":19652,"journal":{"name":"Orthodontics & Craniofacial Research","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012702","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":"Artificial Intelligence in Orthodontics: Part 1-Basic Concepts.","authors":"Fatemeh Sohrabniya, Khuram Naveed, Hossein Mohammad-Rahimi, Julian Woolley, Sara Haghighat, Peter Bangsgaard Stoustrup, Ruben Pauwels","doi":"10.1111/ocr.70179","DOIUrl":"https://doi.org/10.1111/ocr.70179","url":null,"abstract":"<p><p>Artificial intelligence (AI) is increasingly being integrated into orthodontic research and clinical practice. This review paper consists of three parts and aims to establish a foundational understanding of AI concepts for readers from non-technical backgrounds while familiarising them with its applications and challenges within the field of orthodontics. The first part provides a comprehensive introduction to the basic concepts of AI, including definitions of machine learning and deep learning models, alongside various learning types: Supervised, unsupervised, and reinforcement learning. To explain how learning occurs and how to optimise it during model training, key features of the \"learning\" process are introduced. A detailed overview of supervised learning is presented, including data preparation, model selection, and performance evaluation. Following this introduction, different architectures and algorithms of machine learning and neural networks are examined, with examples of their applications in orthodontics, including benefits for clinical decision-making, image processing, and patient monitoring. Finally, this review will consider innovations in AI that hold promise for enhancing orthodontic practice, such as the use of synthetic data, transformers, generative models, and large language models.</p>","PeriodicalId":19652,"journal":{"name":"Orthodontics & Craniofacial Research","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012700","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":"Sequential Machine Learning Approach to Support Premolar Extraction Decisions in Orthodontics.","authors":"Carlos Andres Ferro Sanchez, Sandra Esperanza Nope-Rodríguez, Cristian Orlando Diaz Laverde, Gilber Alexis Corrales, Oscar Iván Campo Salazar","doi":"10.1111/ocr.70187","DOIUrl":"https://doi.org/10.1111/ocr.70187","url":null,"abstract":"<p><strong>Objective(s): </strong>To develop and validate an innovative sequential machine learning framework for premolar extraction decision-making in orthodontics, addressing critical gaps in existing machine learning models and providing transparent clinical reasoning through advanced interpretability techniques.</p><p><strong>Materials and methods: </strong>Five hundred adult patients from Cali, Colombia (88.4% mestizo, 11.6% Afro-Colombian) were analysed using 36 orthodontist-selected variables and evaluated eight supervised learning algorithms. Implemented a novel two-stage sequential architecture, where mandibular extraction predictions informed maxillary decisions, similar to human clinical reasoning. This approach utilized a comprehensive interpretability analysis, including SHAP, permutation importance and partial dependence plots, to ensure clinical transparency and educational value.</p><p><strong>Results: </strong>The sequential framework achieved high performance, with 92% mandibular accuracy (Gradient Boosting), 93% maxillary accuracy (XGBoost) and an overall accuracy of 92.5%, surpassing the best previous result by 8.3%. The machine learning model successfully classified all nine symmetric extraction combinations, compared to only five in prior studies. Interpretability analysis revealed clinically meaningful thresholds for L1-APog (4.88-6.37 mm) and lower crowding, with mandibular decisions having a strong influence on maxillary predictions.</p><p><strong>Conclusion: </strong>This new sequential architecture not only mimics clinical human reasoning but also provides transparent, evidence-based recommendations for mestizo populations. By bridging machine learning with practical clinical application, this tool establishes a new way for AI-assisted orthodontic treatment planning.</p>","PeriodicalId":19652,"journal":{"name":"Orthodontics & Craniofacial Research","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990950","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}