Background/Objectives: The rotation of maxillary canines represents one of the least predictable movements with clear aligners, particularly in cases requiring rotations greater than 10°, due to the rounded crown morphology and limited aligner grip. The aim of this retrospective study was to compare three different crescent-shaped attachment designs (vertical, horizontal, and oblique) for maxillary canine rotations greater than 10° with clear aligners. Methods: Seventy-eight maxillary canines were retrospectively selected and allocated into three equal groups (n = 26) according to the orientation of the applied attachment: vertical, horizontal, or oblique crescent-shaped attachments. Digital STL models (initial, predicted, and final) were imported into Dolphin 3D software 12.0.63 to assess the accuracy of maxillary canine’s rotation through the comparison between planned and achieved values. Results: Mean rotational accuracy was 55.10% ± 15.60 for the vertical group, 62.40% ± 16.10 for the horizontal group, and 64.60% ± 19.40 for the oblique group. One-way ANOVA showed no statistically significant differences among groups (p = 0.09). Pairwise analysis revealed a statistically significant difference between the oblique and vertical designs (p = 0.05). Conclusions: Attachment orientation may influence the accuracy of maxillary canine rotation with clear aligners, with oblique crescent-shaped attachments showing a trend toward improved rotational control.

Objectives: To compare the agreement, reliability and convergent validity of the five‐point ordinal Likert scale and a 100 mm visual analog scale (VAS) for three‐dimensional (3D) esthetic assessment of primary unilateral cleft lip repair using a counterbalanced crossover design. Materials and Methods: Fifty lay observers (25 males, 25 females) evaluated 3D stereophotogrammetric facial models of 10 children with nonsyndromic unilateral cleft lip and palate at three time points: preoperative (T0), 1‐month postoperative (T1), and 6‐months postoperative (T2). Nine morphological items were assessed using both the five‐point Likert scale and a 100 mm VAS. A counterbalanced crossover design with a 2‐week washout period and inversion of scale order was implemented to minimize recall and order effects. Pairwise agreement analyses between the categorized VAS and the five‐point Likert scale (interscale, test–retest, presentation‐mode, and longitudinal agreement) were assessed using Cohen’s kappa ( κ ). Overall inter‐rater reliability was evaluated using the intraclass correlation coefficient (ICC), while convergent validity between the categorized VAS and the five‐point Likert scale was assessed using Spearman’s rank correlation coefficient. Results: Pairwise agreement between the categorized VAS and the five‐point Likert scale ranged from κ = 0.54 to κ = 0.80, indicating moderate‐to‐substantial agreement. Overall inter‐rater reliability was excellent for both instruments (ICC = 0.849–0.982). Test–retest agreement was slight to fair ( κ = −0.05 to 0.49), while agreement between full‐face and cropped image presentation was generally limited ( κ = −0.01 to 0.43). Longitudinal agreement across surgical stages was uniformly slight ( κ = −0.05 to 0.18), reflecting expected changes in postoperative morphology rather than measurement instability. Convergent validity between the categorized VAS and the five‐point Likert scale was excellent (Spearman’s ρ = 0.948–0.974; all p < 0.001). Subgroup analyses by evaluator sex and cleft index revealed no consistent patterns. Conclusions: Both the five‐point Likert scale and the VAS demonstrated excellent overall inter‐rater reliability and excellent convergent validity. However, because agreement analyses required categorization of the continuous VAS, the present findings do not establish whether preservation of its continuous measurement properties would provide additional discriminatory capability. Clinical Relevance: For 3D esthetic assessment of primary unilateral cleft lip repair, both the five‐point Likert scale and the VAS provide reliable group‐level evaluations. Standardized image presentation protocols and the use of multiple evaluators are recommended to improve the consistency of esthetic auditing.

Introduction: Infantile Refsum disease (IRD) is considered one of the milder phenotypes within the Zellweger Spectrum Disorders (ZSDs), a group of peroxisomal biogenesis disorders characterized by a generalized impairment of peroxisomal function. Pathognomonic features of IRD are growth retardation, hearing and cognitive impairment, neuromuscular problems, and craniofacial anomalies. Due to the relatively short lifespan, severe dental anomalies have not been previously reported in association with this disorder. This case report describes a rare manifestation of multiple impacted teeth and near complete edentulism in an adult patient diagnosed with Infantile Refsum disease (IRD). Material and Methods: The patient, a 24-year-old female, presented with a skeletal Class III malocclusion, severe maxillary hypoplasia, and complete impaction of the permanent dentition. The diagnosis of Infantile Refsum disease (IRD) was genetically confirmed and was associated with both neurological and dermatological manifestations. Conclusions: This case underscores that severe disturbances in tooth eruption and impaction may represent underrecognized manifestations of metabolic and genetic disorders such as Infantile Refsum disease (IRD). Dental professionals should remain vigilant to the potential association between systemic conditions and delayed or failed tooth eruption, emphasizing the need for interdisciplinary management and further investigation.