This study had two aims. First, we aimed to investigate the prevalence of ACB, PCB, and oral habits among a group of Albanian children with ASD compared with a group of children without ASD. Second, we aimed to identify the associations of ASD with ACB, PCB, and oral habits. The sample inlcuded 125 children with ASD (91 males, 34 females) from 2 special schools for children with disabilities and 2 daily residential centers in Tirana. The control group included 125 children without ASD. The relationships between categorical variables were evaluated via the chi-square test. To identify the potential risk factors for ASD, we performed binary logistic regression. No statistically significant differences were found for CB or oral habits between the primary and adolescent dentition stages. A comparison of children with ASD with CB and oral habits revealed a significant difference in the prevalence of PCB. Binary logistic regression revealed that ACB, PCB and oral habits were not associated with ASD. CB was more prevalent among children with ASD in the primary and mixed dentition stages. Oral habits were more prevalent in the mixed and adolescent dentition stages. However, ASD is not a risk factor for CB or other oral habits.

Mid-root fractures are rare injuries in young permanent teeth and tend to have poor prognoses. This study presents a case of oblique root fracture of both maxillary immature central incisors in the middle third accompanied by delayed dental visit and severe caries of all primary teeth. After restoring all the primary and permanent teeth that needed stabilization, the coronal fragments were repositioned and stabilized with a flexible splint consisting of orthodontic wire and composite resin. A comprehensive and sequential dental treatment for other oral diseases and oral hygiene instructions were provided. A 16-month follow-up revealed that the two injured young permanent incisors were healed, surrounded by hard tissues and continued to grow both in length of the root and thickness of the root canal wall, with significant improvement in oral hygiene. Based on the outcome of this case, initial stabilization without endodontic therapy could be considered a successful treatment modality for young permanent teeth with oblique root fracture due to the growth of fractured teeth with vital pulp and the maintenance of natural dentition.

OBJECTIVE: In the interpretation of panoramic radiographs (PRs), the identification and numbering of teeth is an important part of the correct diagnosis. This study evaluates the effectiveness of YOLO-v5 in the automatic detection, segmentation, and numbering of deciduous and permanent teeth in mixed dentition pediatric patients based on PRs.
METHODS: A total of 3854 mixed pediatric patients PRs were labelled for deciduous and permanent teeth using the CranioCatch labeling program. The dataset was divided into three subsets: training (n = 3093, 80% of the total), validation (n = 387, 10% of the total) and test (n = 385, 10% of the total). An artificial intelligence (AI) algorithm using YOLO-v5 models were developed.
RESULTS: The sensitivity, precision, F-1 score, and mean average precision-0.5 (mAP-0.5) values were 0.99, 0.99, 0.99, and 0.98 respectively, to teeth detection. The sensitivity, precision, F-1 score, and mAP-0.5 values were 0.98, 0.98, 0.98, and 0.98, respectively, to teeth segmentation.
CONCLUSIONS: YOLO-v5 based models can have the potential to detect and enable the accurate segmentation of deciduous and permanent teeth using PRs of pediatric patients with mixed dentition.

In orthodontic treatment of patients during the mixed dentition period, arch expansion and opening deep overbite are one of the objectives to achieve proper alignment of the teeth and correction of sagittal and vertical discrepancies. However, the expected outcomes of most therapeutic regimens are not clear, making it impossible to standardize early treatment effects. Therefore, this study was designed to evaluate the impact of the Invisalign® First System on the dental arch circumference and incisor inclination in patients during the mixed dentition period. A total of 21 children during the mixed dentition period (10 females and 11 males, with an average age of 8.76 years) were included in this study. The patients received non-extraction treatment through Invisalign® First System clear aligners, and no other auxiliary devices were used except Invisalign® accessories. Subsequently, the cooperation degree of patients during treatment and the oral measurement parameters at the beginning (T1) and the end (T2) of treatment were collected. All patients showed moderate/good cooperation degree during treatment. Besides, horizontal width of the maxillary first molar increased significantly; the designed arch expansion was 4.1 mm (±1.4 mm), while the actual arch expansion was 3.0 mm (±1.7 mm). Furthermore, the torque expression rate of upper anterior teeth reached 56.53%. Invisalign® First System clear aligners can effectively correct the teeth of patients during the mixed dentition period, widen the circumference of dental arch, and control the torque of incisors.

OBJECTIVE: To investigate the relationship between oral muscle pressure and malocclusion in the mixed dentition.
METHODS: Maximum tongue, lip and cheek pressure was measured using the Iowa Oral Performance Instrument (IOPI) in 3 patient cohorts: patients with (1) posterior crossbite, (2) class II relationship and (3) a control group of patients without malocclusion. Linear models were used to compare the mean differences in muscle pressure between groups, with correction for age and gender. The imbalance between lips and tongue and between lips and cheeks was calculated by the Delta z-scores of each group.
RESULTS: A total of 146 participants were included, 46 (mean age 8.71±0.85), 41 (mean age 11.74±1.17) and 35 (mean age 10.71±1.92) in groups 1, 2 and 3 respectively. Patients with malocclusion showed significantly higher lip and lower cheek pressure and imbalance favouring the lips over the tongue compared to controls. Class II,1 patients showed significantly higher tongue pressure than Class II,2. No differences were found in muscle pressure or imbalance between crossbite and Class II nor between crossbite types.
CONCLUSIONS: These findings suggest that oral muscle pressure may be associated with malocclusion. This highlights the importance of functional diagnosis and its implications on the prevention and treatment of malocclusion, as well as on orthodontic stability.

BACKGROUND: to evaluate the predictability of expansion achieved in patients in early mixed dentition treated with Clear Aligners (CA), analyzing the efficiency of the expansion at the end of the first set of aligners and at the end of the therapy in the upper and lower arch.
METHODS: 36 patients (20 F, 16 M; mean age 8.3 ± 1.5 years) were selected retrospectively from the Department of Orthodontics of the Hospital of Rome \"Tor Vergata\". All subjects were treated with CA with no other auxiliaries than attachments. For each patient a standardized sequential expansion protocol was planned for both arches. Digital dental casts were created at three observation periods from an intraoral scanner: prior to treatment (T0), at the end of the first set of aligners (T1), at the end of treatment (T2). The 3D models in planned position determined by the first Clincheck (CC) were obtained for comparison with T1 and T2. Six linear transversal measurements were used to evaluate the dimensional changes and the predictability of expansion movements, comparing T1-CC and T2-CC.
RESULTS: a statistically significant increase within the pre-treatment and the final outcomes for all the variables examined was found. In the upper arch, the greatest level of predictability was detected at the level of the first (46.44%) and second deciduous molar width (44.95%) at T1. The analysis of T2-CC changes showed a significant increase in the percentage of predictability of expansion at the level of the first permanent molars, at mesial (54.86%) and distal (58.92%) width. In the lower arch, a higher percentage of predictability than the upper arch was reported at T1-CC and T2-CC, with the greatest values at the level of second (T1-CC: 48.70%; T2-CC: 75.32%) and first deciduous molar width (T1-CC: 45.71%; T2-CC: 72.75%).
CONCLUSIONS: CA can induce significant transversal increments. The predictability of expansion is variable, but it did not exceed the 50% during the first set of aligners. It was necessary to apply refinement set to achieve a good predictability for expansion of about 70%. The expansion in the lower arch was observed to be more predictable than in the upper arch.

BACKGROUND: Unilateral posterior crossbite is a common malocclusion, and early treatment is recommended to enable normal growth. There are several possibilities regarding choice of appliances used for correcting this malocclusion; however, when treatment is financed by public funds the decision needs to be based not only on the effects but also on the effect in relation to the costs.
OBJECTIVE: The aim was to perform a cost-effectiveness analysis comparing quad helix (QH) and rapid maxillary expanders (RME; hyrax-type) in children in the early mixed dentition.
METHODS: Seventy-two patients were randomized to treatment with either QH or RME, at two different centres. Data were collected from the patient\'s medical records regarding success rate, number of visits, total treatment time, emergency visits, and so forth, together with answers from patient questionnaires concerning absence from school and use of analgesics. A cost-effectiveness analysis with both an intention-to-treat (ITT) and a per-protocol approach was performed, as well as a deterministic sensitivity analysis.
RESULTS: The success rate, one year after the completion of the expansion, was equal between groups according to the ITT approach. From a healthcare perspective, the mean cost difference between RME and QH was €32.05 in favour of QH (P = 0.583; NS). From a societal perspective, the mean cost difference was €32.61 in favour of QH (P = 0.742; NS). The total appliance cost alone was higher in the RME group €202.67 resp. €155.58 in the QH group (P = 0.001). The probability of RME having a higher cost was 71% from a healthcare perspective and 62.7% from a societal perspective. The total treatment time was 97 days longer in the QH group. In the deterministic sensitivity analysis, when using a higher valuation of the children\'s educational loss, the QH becomes €58 more costly than the RME. There was a statistically significant difference in chair time and visits between centres (P < 0.001).
CONCLUSIONS: The difference in costs between RME and QH is not statistically significant, however, there is a slightly higher probability that RME is more expensive than QH with a mean cost of an additional €32 per patient from a healthcare perspective. Different work procedures at different centres indicate that logistics around the patient\'s treatment is a more important aspect than appliance used to decrease the number of visits and save chair time and thereby also costs.

The aim of this study was to evaluate the convergence between the domains of the Autoquestionnaire Qualité de Vie Enfant image (AUQUEI) and the Child Perceptions Questionnaire (CPQ8-10) in the mixed dentition. A sample of 676 children aged 8 to 10 years responded to the health-related quality of life (HRQoL) and oral health-related quality of life (OHRQoL) questionnaires using the AUQUEI and the CPQ8-10, respectively. Clinical (dental caries and malocclusion) and socioeconomic variables were assessed. The validity of convergence between scores (total and per domain) of the two instruments was assessed by Spearman correlation analysis, considering that non-zero coefficient values represented a correlation between scores. The median was calculated to compare the scores of each questionnaire relative to the variables, and the nonparametric Mann-Whitney test was applied to determine statistically significant differences between the categories. A weak significant correlation (between 0.30 and 0.50) was observed between the domains and the total scores of instruments (p < 0.05), except for the leisure domain (p > 0.05). Participants with a lower family income had worse HRQoL (p < 0.05), and those with caries and malocclusion experience had worse OHRQoL (p < 0.05). In conclusion, the AUQUEI and CPQ8-10 instruments showed a weak correlation. Income and clinical variables had a negative impact on the AUQUEI and CPQ8-10, respectively.

BACKGROUND: There are different methods for determining the required space for unerupted teeth. However, the accuracy of these techniques varies depending on ethnic differences. Therefore, the current study was performed to compare the accuracy of four methods for estimating the mesiodistal width of unerupted canines and premolars in a population of northern Iran.
METHODS: The present cross-sectional study was conducted on 50 pairs of dental casts of patients aged 12-24 years old. The mesiodistal width of the teeth was measured with a digital caliper by two observers (ICC < 0.9), and the mean value was recorded. The space required for eruption of canines and premolars was obtained by the Tanaka-Johnson formula and the Moyers tables and compared with the actual value by paired t test.
RESULTS: The Tanaka-Johnson formula had overestimation in the maxilla and mandible, which was statistically significant (p < 0.001). The values obtained from the Moyers tables in different confidence levels were not accurate. However, the 65% level for the mandible had almost no difference from the actual value (P = 0.996 and r2 = 0.503). Furthermore, linear regression was obtained based on the total mesiodistal width of the maxillary first molar and mandibular central incisor (maxilla: Yx= 0.613X + 2.23 and mandible: Ym= 0.618X + 1.6) and the total mesiodistal width of the mandibular first molar and maxillary central incisor in each jaw (maxilla: Yx = 0.424X + 5.021 and mandible: Ym = 0.447X + 3.631).
CONCLUSIONS: The Tanaka-Johnson method was overestimated in the population of northern Iran. The 85% and 75% confidence levels of the Moyers table have the best clinical results for the maxilla and mandible, respectively. Regression based on maxillary first molars and mandibular central incisors has better results.

OBJECTIVE: To measure the gingival phenotype-related features, gingival thickness (GT) and gingival width (GW), in healthy children and to investigate their association between them, with age, gender, tooth-type and arch.
METHODS: The gingival sites of 1029 teeth were included from 64 children (36 males and 28 females), with primary and mixed dentition, attending the paediatric dental clinic of Aristotle University, Thessaloniki. GT and GW were measured ultrasonically and with a periodontal probe, respectively. Mixed effects linear regression models were used to evaluate the association of gingival thickness and gingival width with the under-investigation parameters. Spearman\'s correlation coefficient was used to evaluate correlation between GT and GW.
RESULTS: Significantly thicker gingiva is found in posterior teeth compared to anterior teeth, in permanent teeth versus primary teeth and in maxillary teeth in comparison to mandibular teeth (p value < 0.001). Regarding GW, significantly wider gingiva is noted in posterior regions (p value = 0.022) and the maxilla (p value < 0.001). Gender-wise and concerning age GT and GW are not significantly affected. A weak and positive correlation between GT and GW is noted (rho 0.30, p < 0.001).
CONCLUSIONS: GT and GW present significant associations with arch and tooth-type. Findings from this study fulfil the further understanding of GT and GW of paediatric patients that are investigated sparsely throughout the literature and demonstrate an accurate, painless and simple method to map the gingiva.