Class II malocclusions, characterized by the mesial positioning of the maxillary molars relative to the mandibular molars, are among the most frequently encountered orthodontic issues. One of the widely adopted non-extraction approaches for addressing this malocclusion is maxillary molar distalization, which has been utilized for decades to create space within the dental arch. Historically, extraoral appliances such as headgear were commonly employed. However, with technological advancements, intraoral distalization devices, particularly those incorporating temporary anchorage devices (TADs), have gained prominence due to their compact size, not being visible externally, and improved patient acceptance. These appliances offer significant advantages, including being less invasive compared with extraction-based camouflage treatments, being more readily accepted by patients due to the absence of extraction spaces, and not requiring the complex biomechanical principles involved in extraction-based methods. TADs have revolutionized distalization techniques by providing superior anchorage control, reducing treatment duration, and offering a straightforward, patient-friendly application. The purpose of this comprehensive narrative review is to focus specifically on intraoral distalization techniques utilizing TADs, summarizing their efficacy and outcomes in the management of Class II malocclusions as reported in clinical studies over the past three decades.

Background/Objectives: Although there has been extensive research on the orofacial morphologic effects of cleft lip and palate (CLP), the effects of CLP on mandibular structures remain largely unknown. The aim of this study was to investigate the trabeculation differences in the mandibular osseous architecture of patients with bilateral CLP (BCLP) and left-sided unilateral CLP (UCLP) using fractal dimension (FD) analysis and to compare these findings with healthy controls without CLP. Methods: A total of 63 patients (27 females, 36 males) with a mean age of 9.69 ± 1.5 years in the pre-peak growth stage were divided into three groups (n = 21 per group): the control group (CG), the BCLP group, and the UCLP group. The FD analysis was conducted on selected regions of interest (ROIs) from the mandibular condyle, angulus, corpus, and coronoid areas in TIFF-formatted panoramic radiographs. Statistical analyses were performed using the paired t-test and ANOVA for parametric data, and the Wilcoxon and Kruskal–Wallis tests for nonparametric data. Statistical significance was set at p < 0.05. Results: The FD values obtained from the ROIs of the right condyle were found to be significantly lower in the BCLP group compared to the CG and UCLP groups (p < 0.05). Conversely, the FD values for the left condyle were significantly higher in the CG group (p < 0.05), while no significant differences were observed between the BCLP and UCLP groups (p > 0.05). The FD value of the left condyle in the UCLP group was found to be significantly lower than that of the right condyle (p < 0.05). In the CG group, the FD values for both the right and left mandibular condyle and corpus were significantly higher than those for the angulus and coronoid regions; in the UCLP group, only the FD values of the right mandibular condyle and corpus were significantly higher than those for the same regions (p < 0.05). Conclusions: The reduced FD values in the mandibular condyle of CLP patients during the pre-peak growth stage suggest a loss of trabeculation and lower metabolic activity, while similarly, reduced FD values in the corpus region contribute to delayed tooth eruption timing, likely due to decreased masticatory forces during the intercuspal position and altered occlusal relationships. Clinical Relevance: In treating CLP patients, particularly with orthopedic face masks, the reduction in metabolic activities in these areas should be considered to achieve the optimal mandibular growth and development, and dental eruptions during the distribution of force from the chin to the corpus and condyle.

Objective: The study aims to evaluate the effectiveness of deep learning algorithms in skeletal age estimation by comparing the diagnostic reliability of five different hand‐wrist maturation (HWM) assessment methods. Materials and Methods: A total of 6572 hand‐wrist radiographs from orthodontic patients aged 8–16 years were retrospectively analysed. Radiographs were categorised into five groups based on HWM classification methods: (I) Björk's nine‐stage, (II) Hägg and Taranger's five‐stage, (III) Chapman's four‐stage, (IV) three‐stage hook of hamate ossification based and (V) simplified three‐stage Björk's classification based. YOLOv8x‐based deep learning models were trained separately for each group. The dataset was split into training, validation and test subsets. Performance was evaluated using accuracy, precision, recall, F1 score and AUC metrics. Results: The YOLOv8x‐cls model demonstrated high classification performance across all five groups. Group IV and Group II achieved the highest accuracy and F1 scores, with average F1 values of 0.99 and 0.96, respectively. Group III and Group V also showed strong performance (F1 = 0.93 and 0.92). In Group I, slightly lower classification performance was observed in the S‐H2 and MP3‐Cap stages (F1 = 0.72–0.74), which correspond to the pubertal growth peak, while early and late skeletal maturation stages were classified with high accuracy and F1 scores. ROC curve analysis further supported these findings, with AUC values for MP3‐Cap and S‐H2 recorded as 0.70 and 0.75, respectively, whereas higher AUC values were achieved in most other stages across all groups. Conclusion: Deep learning models proved effective in evaluating skeletal maturation across five different HWM methods. Particularly high performance was observed in anatomically distinct regions such as the MP3, adductor sesamoid and hamate bone, which can be reliably identified by general dentists, enabling earlier referrals and timely orthodontic interventions.

This study aimed to evaluate total maxillary arch distalization using three different skeletal anchorage systems—Mini Screw-Assisted Keleş Slider (MKS), infrazygomatic crest (IZC) screw, and maxillary tuberosity (MT) screw—through finite element analysis (FEA). A 3D cranio-maxillary model including dentition, periodontal ligament, and alveolar bone was constructed. For the MKS and IZC groups, forces were applied at three vertical heights (0 mm, 3 mm, and 6 mm apically), while the MT group involved three directional applications: buccal, palatal, and combined bucco-palatal. This design yielded nine distinct simulation scenarios. Tooth movements were assessed along the x (transverse), y (sagittal), and z (vertical) axes, and Von Mises stress distributions were analyzed in surrounding structures. In the MKS group, the first scenario showed the greatest molar crown displacement, while the third had the highest root-level movement. The ninth MT scenario yielded the most palatal crown displacement of incisors, while the sixth IZC scenario showed the greatest root movement. Apical force applications (MKS and IZC at 3–6 mm) allowed controlled displacement suited for Class II Division 2 malocclusions. In contrast, archwire-level and MT scenarios produced patterns favorable for Class II Division 1 cases. Anchorage type and force direction significantly affected distalization outcomes.

Medical Journal of Western Black Sea | Volume: 8 Issue: 1