Background/Objectives: Sleep-Disordered Breathing (SDB) in children is closely associated with craniofacial growth and orthodontic conditions. Early identification of SDB risk in orthodontic populations is crucial, yet evidence remains fragmented. This systematic review aimed to summarize the prevalence of high SDB risk in pediatric orthodontic patients assessed through validated questionnaires. Methods: A systematic search was conducted across PubMed, Scopus, Web of Science, Cochrane Library and Embase following PRISMA guidelines. Inclusion criteria comprised analytical cross-sectional studies assessing SDB risk in children undergoing or seeking orthodontic treatment, using validated questionnaires such as the Pediatric Sleep Questionnaire (PSQ), OSA-18, or Sleep Clinical Record (SCR). The methodological quality of the included studies was assessed using the “JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data”. The certainty of the evidence was additionally evaluated using the GRADE approach. Results: Twelve studies published between 2011 and 2025 met the inclusion criteria, totaling 3737 participants. Across studies, the mean prevalence of high SDB risk ranged from a minimum of 1.2% to a maximum of 69%, with consistently higher values in populations exhibiting malocclusions, oral breathing patterns, or craniofacial risk markers. All studies clearly described their populations and used validated screening tools, resulting in moderate overall quality. Conclusions: Pediatric orthodontic populations demonstrate a substantial prevalence of high SDB risk, suggesting that orthodontists should systematically incorporate validated questionnaires into routine screening. The evidence base, although consistent, remains limited by methodological weaknesses. Further well-designed studies are needed to clarify causal relationships between craniofacial development and SDB.

Background: The orthodontist can play an important role in the early detection of sleep-disordered breathing (SDB), aiding in the prevention of dentoskeletal complications and systemic issues. Early intervention supports proper pediatric development, emphasizing the need for SDB screening in orthodontics. SDB involves abnormal breathing during sleep, with obstructive sleep apnea (OSA) in children presenting unique diagnostic challenges compared to adults. Aim: This study aimed to identify children at risk for SDB through a validated screening questionnaire during orthodontic evaluations. Methods: This prospective study recruited children under 12 years of age between July 2023 and July 2024. The Sleep Clinical Record was used to screen for SDB indicators. Results: Among the 48 participants (31 females, 17 males) aged 5–12 years, 69% were identified as being at risk for SDB. Risk factors included oral breathing, nasal obstruction, tonsillar hypertrophy, malocclusion, high Friedman scores, narrow palates, and positive Brouillette phenotypes, all showing significant correlations (p < 0.05). Conclusion: The findings underline the critical importance of early SDB screening in orthodontic settings. These preliminary results encourage further research on larger cohorts to refine diagnostic tools and interventions. Early recognition and management of SDB can significantly enhance systemic health and craniofacial outcomes in pediatric patients.

Background and Objectives: The impact of orthodontic appliances on oral health-related quality of life (OHRQoL) has gained increasing attention, particularly in relation to patient-centered outcomes. Clear aligners (CAs) are often perceived as more comfortable than fixed appliances (FAs), although evidence remains limited and heterogeneous. This systematic review and meta-analysis aimed to compare the effects of CAs and FAs on OHRQoL in patients with Angle class I malocclusion and to further evaluate the reliability of the findings using trial sequential analysis (TSA). Materials and Methods: This review followed PRISMA guidelines and was registered in PROSPERO (CRD420251051003). A comprehensive search of PubMed, Scopus, Web of Science, Embase, and Cochrane CENTRAL was conducted. Only randomized controlled trials comparing CAs and FAs and reporting OHRQoL outcomes (OHIP-14) were included. Random-effects meta-analyses were performed on early changes in OHRQoL. TSA was applied to control for type I and II errors and to evaluate the sufficiency of the cumulative evidence. Results: Two randomized controlled trials (n = 74) were included in the quantitative synthesis. Both treatments were associated with a transient deterioration in OHRQoL after appliance placement. Meta-analysis showed statistically significant improvements favoring CAs in psychological discomfort (p = 0.007) and psychological disability (p < 0.001), while no significant differences were observed for other domains or for overall OHRQoL. Exploratory TSA suggested an early signal in favor of psychological outcomes, with the cumulative Z-curve crossing the monitoring boundary; however, given the very small number of included trials, these findings should be regarded as preliminary and hypothesis-generating rather than confirmatory. In contrast, for most other outcomes, the required information size was not reached and results remained inconclusive. For handicap, TSA suggested that a clinically relevant difference is unlikely. Conclusions: Clear aligners may provide a modest short-term advantage over fixed appliances in psychological aspects of OHRQoL, while no consistent differences are observed in physical or overall domains, based on very limited evidence. TSA suggests a preliminary signal in psychological outcomes but highlights insufficient evidence for most other domains. These results should be interpreted with caution, and further high-quality randomized trials are needed.

Background: Impaction of mandibular canines is an uncommon clinical condition, and transmigration represents a severe positional variant within this spectrum. In contrast to maxillary canine impaction, the management of impacted mandibular canines remains less standardized and largely experience-based. This systematic review aimed to critically evaluate the clinical outcomes of surgical exposure followed by orthodontic traction in impacted mandibular canines. Methods: A systematic search was conducted across five electronic databases (PubMed, Web of Science, Scopus, Embase, and Cochrane Library) up to February 2026. A total of 1512 records were identified; after duplicate removal, 1307 studies underwent title and abstract screening. Fifteen full-text articles were assessed for eligibility, and four retrospective analytical studies met the predefined inclusion criteria. The primary outcome was successful orthodontic alignment. Secondary outcomes included treatment duration and reported complications. Risk of bias was assessed using ROBINS-I, and certainty of evidence was evaluated according to the GRADE approach. Results: Success rates ranged from 57% to 100% across studies. Overall, 31/42 canines (73.8%) were reported as successfully aligned; however, heterogeneity in case selection, outcome definitions, and reporting precluded quantitative synthesis. In most studies, success was defined primarily as positional alignment within the dental arch, with limited or absent assessment of periodontal status, pulp vitality, functional integration, or long-term stability. All included studies were judged to have a serious overall risk of bias. According to GRADE, the certainty of evidence for all evaluated outcomes was very low. Conclusions: Surgical exposure followed by orthodontic traction may represent a feasible option in carefully selected cases of impacted mandibular canines, particularly in younger patients and in the absence of severe displacement. However, given the serious risk of bias, small cumulative sample size, and very low certainty of evidence, these estimates must be interpreted with extreme caution. Unlike maxillary canine impaction, the current evidence base does not support protocol-driven management for mandibular cases, and clinical decision-making remains primarily individualized.

Background/Objectives: Transverse maxillary deficiency in growing patients can be treated using rapid maxillary expansion (RME) or slow maxillary expansion (SME) with spring-based appliances, such as the Leaf Expander (LE), but their comparative dentoskeletal effects remain debated. This study evaluated the transverse dentoskeletal outcomes of LE-based SME versus conventional RME. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO. Electronic searches were performed in PubMed, Scopus, Embase, Web of Science, and Cochrane Library up to 9 January 2026. Randomized controlled trials (RCTs) comparing LE-based SME and RME in skeletally immature patients were included. Primary outcomes were transverse maxillary change; secondary outcomes included dentoalveolar side effects. Risk of bias was assessed using the RoB 2 tool, and certainty of evidence was evaluated using the GRADE framework. When possible, a meta-analysis was performed using standardized mean differences and a random-effects model. Results: Four RCTs met the inclusion criteria. Both SME and RME achieved significant transverse expansion. Meta-analysis showed no statistically significant differences between protocols for inter-canine distance, inter-second deciduous molar distance, inter-first permanent molar distance, or basal maxillary width. Intergroup differences varied by anatomical site and measurement method: RME showed greater anterior dental and skeletal transverse gains, whereas SME achieved comparable intermolar expansion with greater molar distorotation. Three-dimensional analyses indicated similar morphological enlargement. Risk of bias ranged from low to high; the certainty of evidence was low to very low for most transverse parameters and moderate only for molar distorotation. Conclusions: Both LE-based SME and RME effectively correct transverse maxillary deficiency. Quantitative synthesis showed comparable overall transverse expansion, with differences mainly related to the distribution and biomechanical pattern of dentoskeletal effects rather than the absolute amount of expansion achieved. Appliance selection should be guided by biomechanical features and individual treatment objectives. Further high-quality RCTs with standardized three-dimensional protocols and longer follow-up are needed.