Dentistry

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Long-term Stability of Skeletal, Dental, and Facial Esthetic Outcomes Following Maxillary Distraction Osteogenesis with Rigid External Distractor in Subjects with Cleft Maxillary Hypoplasia
(2026-04-20) Kim, Youkyung; Sheller, Barbara
Background: Maxillary hypoplasia, common in patients with cleft lip and palate, presents significant functional and esthetic challenges, including Class III malocclusion, negative overjet, and midface retrusion. While conventional Le Fort I osteotomy is effective for skeletally mature patients, growing patients are not eligible. Maxillary distraction osteogenesis using a rigid external distractor (MXDO-RED) is a surgical treatment for correcting severe maxillary hypoplasia and can be performed in growing individuals. Long-term data on stability following MXDO-RED, however, is limited by small sample sizes and short follow-up durations. Objective: This retrospective study evaluated the long-term skeletal stability of MXDO-RED in patients with severe maxillary deficiency associated with cleft lip and palate. Additionally, the study aimed to assess the association between maxillary stability following MXDO-RED and factors including age at distraction, magnitude of advancement, mandibular growth, and mandibular plane angle. Methods: A retrospective analysis was conducted on 60 subjects with severe cleft maxillary hypoplasia who underwent Le Fort I level MXDO-RED at a craniofacial center from 2008 to 2023. Records, including lateral cephalograms, extraoral and intraoral photos, and dental models, were analyzed at four time points: pre-operative (T0), immediate post-operative (T1), first follow-up (T2), and longest available follow-up (T3). Outcomes were categorized into short-term (total follow-up duration of 0.5 to 3 years post T1) and long-term (total follow-up duration of greater than 3 to 6.5 years post T1) post distraction follow-up groups. Generalized estimating equations (GEE) linear regression was used to evaluate longitudinal stability and the association between stability and secondary factors. Results: Significant improvements in maxillary retrusion, facial profile, upper lip position, overjet, and crossbite were observed following MXDO-RED. The mean age at the time of distraction was 14.9 + 1.7 years. The mean sagittal advancement at A-point was 12.7 + 5.6 mm. Significant sagittal relapse was observed in both the short-term group (−3.5 + 5.2 mm; 27.8% of advancement; p < .001) and the long-term group (−5.5 + 6.0 mm; 42.6%; p < .001). Longitudinal regression confirmed a significant posterior relapse of −0.9 mm per year over the follow-up period for both groups (95% CI: -1.6 to -0.2; p = .011). No significant vertical changes were observed (p = .850). The magnitude of initial advancement was the strongest factor associated with maxillary sagittal relapse. Each additional millimeter of sagittal advancement was associated with 0.42 mm of subsequent horizontal relapse (95% CI: -0.62 to -0.23; p < .001) and 0.88 mm of vertical relapse (95% CI: -1.03 to -0.74; p < .001). Mandibular body growth (Gonion–Menton) was significantly associated with both sagittal (p = .005) and vertical (p = .041) maxillary displacement after adjusting for follow-up duration. Age at distraction and mandibular plane angle were not significantly associated with relapse. Upper lip position demonstrated significant progressive retrusion over the follow-up period (p = .011). Of the 57 subjects for whom status of further orthognathic surgery could be determined, secondary orthognathic surgery was completed or planned for 50.9%, and 49.1% of subjects did not require further surgery. Conclusion: MXDO-RED achieves substantial correction of severe maxillary hypoplasia in growing patients with cleft lip and palate with significant improvements in facial profile and occlusion. Sagittal relapse approaching half of the initial advancement in the long term presents a clinical challenge. The strong association between magnitude of advancement and mandibular body growth and maxillary displacement underscores the multifactorial nature of post-distraction instability. The finding that half of subjects required secondary orthognathic surgery reinforces the importance of follow-up through skeletal maturity and preoperative counseling that MXDO-RED in growing patients may represent a single stage of a multi-stage treatment course.
Transverse Changes in Combined Orthodontic and Surgical Treatment with Segmental LeFort I Osteotomy: Comparing Aligners with Fixed Appliances
(2026-04-20) Nguyen, Tammy; Khosravi, Rooz
Background and Objectives:Transverse maxillary expansion by segmental LeFort I osteotomy is historically considered the least stable of all orthognathic movements, with reported molar relapse rates exceeding 30 to 50% in prior literature. Despite this common perception among practitioners, a comprehensive characterization of dental and skeletal transverse dimensional change across all three phases of surgical-orthodontic treatment has not been established. These phases include pre-surgical orthodontics, surgery, and post-surgical orthodontics. Furthermore, no studies have evaluated transverse stability specifically in patients treated with clear aligners and segmental maxillary expansion-despite growing clinical adoption of aligners in orthognathic surgery protocols. The primary objectives of this study were: (1) to characterize transverse dimensional changes at the skeletal and dental levels across each treatment phase, (2) to compare outcomes between patients treated with clear aligners versus fixed appliances, and (3) to identify factors associated with post-surgical transverse constriction. Materials and Methods: This was a retrospective cohort study of 34 patients (15 females, 19 males; mean age 36.1 years) who underwent segmental LeFort I osteotomy for transverse maxillary expansion combined with orthodontic treatment. Patient records were collected from two private oral surgery offices and four private practice orthodontists in the greater Seattle area. Fourteen patients were treated with clear aligners and 20 with fixed appliances. Cone-beam computed tomography was obtained at up to four time points: pre-treatment (T0), before surgery (T1), immediately post-surgery (T2), and completion of treatment (T3). Four transverse measurements were evaluated at each time point: posterior skeletal width, anterior skeletal width, intermolar width (IMW; posterior dental), and inter-canine width (ICW; anterior dental), as well as bilateral buccal-lingual first molar inclination. The fixed appliance group presented with larger pre-treatment transverse discrepancies, a different distribution of treatment time across phases, and was planned for greater surgical expansion compared with the clear aligner group. Statistical analyses included Welch two-sample t-tests, Wilcoxon rank-sum tests, McNemar's test, Pearson correlation, and bivariate linear regression. Results: Pre-surgical orthodontic phase (T1–T0): Pre-surgical orthodontics produced small expansionary changes at both dental levels (IMW: 1.18 ± 1.78 mm; ICW: 0.56 ± 1.78 mm), with no significant between-group differences (IMW: p = 0.572; ICW: p = 0.952). Pre-surgical orthodontics contributed approximately one-third of total net IMW expansion and half of total net ICW expansion. Surgical phase (T2–T1): Mean posterior skeletal expansion was 4.31 ± 2.32 mm overall, with the fixed appliance group achieving significantly greater expansion than the clear aligner group (5.14 ± 2.16 mm vs. 3.04 ± 2.00 mm; p = 0.008). No significant differences between-group were found for anterior skeletal expansion (3.49 ± 2.66 mm overall; p = 0.495), or ICW expansion (0.68 ± 0.88 mm overall; p = 0.854). For IMW expansion, there was a trend toward more expansion in the fixed appliance group (2.61 ± 1.92 mm overall; fixed appliances: 3.04 mm vs. clear aligners: 1.99 mm; p = 0.107). Surgical expansion was greater posteriorly than anteriorly at both skeletal and dental levels. Planned IMW expansion was strongly correlated with achieved expansion across all patients (r = 0.904, p < 0.001), with both groups achieving approximately 96% of planned expansion. Post-surgical phase (T3–T2): Posterior and anterior skeletal changes were minimal and non- significant between groups (posterior: 0.06 ± 0.66 mm overall, p = 0.635; anterior: −0.05 ± 1.93 mm overall, p = 0.200). Significant IMW constriction occurred overall (−2.04 ± 1.35 mm), with greater constriction in the fixed appliance group (−2.62 mm vs. −1.21 mm; p < 0.001). ICW constriction was −0.92 ± 1.12 mm overall (fixed appliances: −1.01 mm; clear aligners: −0.80 mm; p = 0.557). Significant lingual tipping of the right (−3.36 ± 3.56° overall; fixed appliances: −4.40°; clear aligners: −1.88°; p = 0.037) and left first molars (−2.77 ± 3.02° overall; fixed appliances: −3.88°; clear aligners: −1.20°; p = 0.005) occurred, with greater tipping in the fixed appliance group. Regression analysis: Total net IMW expansion (β = −0.28, p = 0.009, R² = 0.22), surgical expansion (β = −0.31, p = 0.010, R² = 0.19), and appliance type (β = −1.41, p = 0.002, R² = 0.27) were significant predictors of post-surgical IMW constriction. Total net ICW expansion (T2–T0) was a significant predictor of post-surgical ICW constriction (β = −0.30, p = 0.004, R² = 0.26). Treatment duration, gender, pre-treatment transverse discrepancy magnitude, and anteroposterior classification were not significantly associated with post- surgical constriction in any measurement. Occlusal outcomes: No patients presented with a posterior crossbite at treatment completion, with no significant difference between appliance groups. Four of 30 patients (13%) who presented with a pre-treatment crossbite ended with edge-to-edge posterior overjet, while none of the four patients without a pre-treatment crossbite developed edge-to-edge overjet (p < 0.001). The rate of edge-to-edge posterior overjet did not differ significantly between appliance groups (clear aligners: 7.1%; fixed appliances: 15.0%; p = 0.627). Conclusions: Skeletal expansion following segmental LeFort I osteotomy was highly stable through treatment completion. Post-surgical changes were predominantly dentoalveolar in nature, with IMW demonstrating the greatest constriction. Expansion magnitude was the most consistent predictor of post-surgical IMW constriction. The greater constriction observed in the fixed appliance group could be attributed to greater expansion magnitude, case complexity, and larger pre-treatment transverse discrepancies in that group. Planned and achieved IMW expansion were strongly correlated, confirming high surgical predictability regardless of appliance type. Within the scope of this study, clear aligners demonstrated adequate ability for achieving surgical expansion and maintaining the transverse dimension during the post-surgical phase through the removal of appliances. These findings should be interpreted within the context of the study's retrospective design, modest sample size, short-term follow-up, and bivariate linear regression approach. Prospective studies with larger sample sizes, multivariable modeling, and long-term follow-up are needed to confirm these findings.
Orthodontic Outcomes in Class II Correction with Elastics: Clear Aligners Versus Fixed Appliances
(2026-04-20) Quinn, Neal MacKendrick; Bayirli, Burcu
Introduction: Clear aligner therapy is rapidly gaining market share and offers aesthetic and hygienic benefits; however, their efficacy in Class II correction with elastics remains under-researched compared to traditional fixed appliances. Specific Aims: This study compares anteroposterior and vertical dentoalveolar, facial, and skeletal changes between clear aligners and fixed appliances. Differences in treatment efficiency and outcome variations between growing versus non-growing patients were evaluated based on technique. Research Design and Methods: This is a retrospective cohort study involving 132 subjects (64 clear aligner, 68 fixed appliance) categorized into growing and non-growing cohorts based on age. Data collection included lateral cephalometric tracings, 3D digital model analysis, and additional treatment factors such as IPR. Linear regression was used to compare post-treatment variance by adjusting for pre-treatment values. Effect of appliance type on each parameter is represented by the coefficient ß. Results: The analysis revealed no significant difference in treatment time between aligners and fixed appliances (~23–25 months). However, fixed appliances showed significantly more buccal crown torque added to incisors, 9.47º (7.10, 11.8) in adolescents and 8.68° (2.02, 15.3) in adults compared to aligners. Clear aligners demonstrated less vertical change, showing significantly less overbite reduction. Conclusions: Each appliance type offers distinct clinical advantages: clear aligners provide better control of lower incisor torque and vertical dimensions, while fixed appliances may be more effective for deep overbite correction. Skeletal and facial changes were largely similar across both modalities, suggesting outcomes are primarily driven by initial dental and biological factors rather than the appliance type.
Premolar Extraction Cases Treated with Aligners: Are Contemporary Results Comparable to Fixed Appliances?
(2026-04-20) Teitelbaum, Rachel; Huang, Greg
Introduction: Historically, it has been challenging to treat premolar extraction cases with aligners to the same occlusal standards as fixed appliances. The purpose of this study was to assess whether premolar extraction cases treated with Invisalign in the past 5 years have more comparable results to cases treated with fixed appliances. Methods: Matched pairs of premolar extraction cases were analyzed from 3 private practice orthodontists considered to be experts in both the fixed appliances and aligner techniques. Pre- and post-treatment records were assessed for (1) occlusal outcomes, (2) treatment efficiency, (3) cephalometric parameters, and (4) root parallelism in extraction cases treated with Invisalign versus full fixed appliances whose treatment was completed in the past 5 years. Results: ABO-OGS and PAR scores were comparable for both groups, showing no statistically significant differences. Aligner cases completed treatment 2 months faster, on average, than fixed appliance cases, but this difference was not significantly different. Cephalometric analyses indicated that at the end of treatment, lower incisors had a greater change in retroclination and overbite was deeper in the aligner group. Teeth adjacent to extraction sites in the aligner group had more divergent roots compared to the fixed group. Conclusion: Occlusal outcomes and treatment efficiency were similar in the aligner and fixed appliances patients treated in the past 5 years. However, incisor angulation, overbite, and root parallelism were not managed as well with aligners.
Changes in Occlusal Contact Area Following Orthodontic Treatment: At Time of Debond and Into Retention
(2026-04-20) Sangster, Anissa; Bollen, Anne-Marie
Introduction: The purpose of this study was to evaluate changes in occlusal contact surface areafrom pre-treatment (T1), post-treatment (T2), and into retention (T3) using 3D models acquired when patients presented for retainer replacement. The influence of patient demographics, treatment characteristics, time since debond and retention types on occlusal contact changes were analyzed. Methods: Patients treated in the University of Washington Orthodontics clinic who obtained an intra-oral scan for the fabrication of new retainers were screened. Inclusion criteria were a history of orthodontic treatment of the permanent dentition with fixed appliances and without orthognathic surgery, the availability of good quality intra-oral scans prior to and after orthodontic treatment, and the absence of restorative treatment since debond. Occlusal contact surface area on the intra-oral scans was analyzed using 3D analysis software across a range of - 1mm to 1mm of inter-occlusal distance between the maxillary and mandibular dentition. Three categories were differentiated: open (0.46 to 1 mm), near (0.21-0.45 mm), and tight (0-0.2 mm) contacts. Surface areas were evaluated for the anterior, posterior, and total dentition at each of the three time points. Changes in occlusal contact surface area were assessed between the three time points (T1-T2, T2-T3 and T1-T3) with subgroup analyses based on age, malocclusion, extraction status, retainer type, and retention time. Results: 60 patients met the inclusion criteria (mean age 15.8 years, 57% female, 43% male, mean time since debond 20.3 months). From T1 to T2, tight and near contact surface area decreased, while open contact surface area increased in the anterior, posterior, and total dentition. From T2 to T3, tight and near contact surface area increased, while open contact surface area decreased in the anterior, posterior, and total dentition. The majority of occlusal contact changes during retention occurred within the first 24 to 36 months following appliance removal. From T1 to T3, there was no significant net change overall for tight, near, and open contacts in the anterior, posterior, and total dentition. Age, extraction status, and retainer type demonstrated limited influence on occlusal contact changes. Class II and III malocclusions exhibited greater increases in near contact surface area and greater decreases in open contact surface area compared with Class I malocclusions, primarily in the total dentition. Conclusions: Orthodontic treatment with fixed appliances temporarily disrupts close occlusal contacts, while retention allows for occlusal settling which increases the occlusal contact areas with a return toward pretreatment values obtained after 24 to 36 months following appliance removal.
Causes and Consequences of Midfacial Hypoplasia in Pigs
(2025-10-02) Baldwin, Michael Caleb; Herring, Susan W; Liu, Zi-Jun
University of Washington Abstract Causes and Consequences of Midfacial Hypoplasia in Pigs Michael Caleb Baldwin Chairs of Supervisory Committee:Susan W. Herring Zi-Jun Liu Department of Orthodontics Midfacial hypoplasia (MFH), or underdevelopment of the upper jaw, nose, and cheek bones, can lead to severe deformity with impairment of breathing. MFH can be life threatening, making treatment imperative, but a lack of understanding about the causes of MFH and how it impairs breathing has limited current treatments. Pigs with MFH served as a new, clinically relevant model for understanding the causes and consequences of MFH. Mild MFH is not uncommon in standard pigs and minipigs, but it is universal and more severe in Yucatan minipigs, making this breed an exceptionally useful model. MFH in pigs is similar to MFH in humans, and pigs better resemble humans in size, anatomy and physiology, and growth than other animal models. The objective of this dissertation was to compare pigs with and without MFH to determine the primary tissue cause of MFH, and to determine whether the structure and function of the nasal and pharyngeal airway in MFH are compromised. Aim 1 tested the hypothesis that the caudal nasal septal cartilage contains an important growth region that ossifies prematurely in MFH pigs, restricting the growth of the midface. The amount and morphology of ossification was measured on computed tomography (CT) images and compared between MFH and normal pigs. The caudal portion of the nasal septum was harvested from normal and affected pigs and examined histologically for chondrocyte replication. MFH pigs had increased ossification, diminishing or even obliterating the cartilage tail, with decreased cell replication and hypertrophy in the caudo-ventral septum. Aim 2 tested the hypothesis that MFH pigs compensate for a short rostrum by increasing the cross-sectional area of their nasal cavity and increasing the size and/or complexity of their conchae to conserve a normal surface area to volume relationship and prevent changes to air conditioning efficiency. Surface area, cross-sectional area, and volume were measured on CT scans. A nasal probe, with dual temperature and humidity sensors, was constructed and used to measure temperature and humidity in the nasal airway. As expected, the cross-sectional area of the nasal airway increased, and the conchae were larger and more complex in MFH pigs. Thus, surface area and volume did not change, and air conditioning was unaffected. Aim 3 tested the hypothesis that MFH constricts the pharyngeal airway due to decreased skeletal space and relative enlargement of the soft tissues. The cross-section of the airway, distance between skeletal restraints, and size of the tongue and soft palate were measured on CT scans. A bulge of tissue on the posterior wall of the pharynx was harvested and examined histologically for tissue properties. The pharyngeal airway was not narrower in MFH pigs, and unexpectedly the nasopharynx was wider. The tissue bulge was composed mostly of fat, which was increased in MFH pigs. In conclusion, the cause of MFH in pigs is related to decreased growth and premature ossification of the caudal nasal septum. Compensation from the conchae conserves surface area to volume in MFH pigs, but the increase in cross-sectional area of the nasal cavity results in a larger nasopharynx and a relatively constricted airway at the site of the bulge, which may predispose MFH pigs to airway obstruction.
Pediatric Dentist Experiences with Caregiver Radiograph and Imaging Refusal
(2025-08-01) Akabike, Andrea; Nelson, Travis
Purpose: This study investigated pediatric dentists’ experiences with caregiver radiograph and imaging refusal and how dentists manage it in clinic. Methods: American Academy of Pediatric Dentistry (AAPD) members were recruited by email from October 2024 to November 2024 to complete an online Research Electronic Data Capture (REDCap) survey on experiences with caregivers who refuse radiographs (intraoral, extraoral, and bitewing) and cone beam computed tomography (CBCT) imaging; bitewing radiograph refusal management; lead shielding practices; and provider and practice characteristics. Bivariate analyses were completed using the Chi-square test to identify practice-level characteristics associated with refusal (α=0.05). Results: Of the 8,342 invited participants, 695 completed the survey (8.3%). Substantial percentages of responding pediatric dentists reported radiograph and CBCT refusal to be a big or medium-sized problem (intraoral=23.2%; extraoral=12.1%; bitewing=21.7%; CBCT=9.0%). Pediatric dentists in private practice were significantly more likely to report radiograph refusal as a big problem than those in community health center/public health clinic or hospital/university settings (P-values<.05); there were no differences in CBCT refusal by setting (P=.85). Pediatric dentists practicing in clinics with >50% Medicaid-enrolled children reported having significantly fewer caregivers who refused radiographs (P-values<.05); there was no difference in CBCT refusal by % Medicaid (P=.42). Dentists believed caregivers who refused immunizations and those who refused fluoride were most likely to refuse bitewing radiographs. Most dentists (81.0%) used lead shielding, for whom the most common reason was that it increased caregiver acceptance of radiographs (73.6%). Conclusions: Radiograph and CBCT imaging refusal are significant clinical challenges, which highlights the importance of developing chairside strategies that pediatric dentists can use to help caregivers make decisions about radiographs and imaging for their children.
The association between intensive parenting attitudes and topical fluoride opposition
(2025-08-01) Ko, Alice; Chi, Donald L
Introduction. Despite evidence that topical fluoride is safe and effective, opposition to it is a growing clinical and public health challenge. Intensive parenting attitudes may affect a caregiver’s preventive care decision-making for their children, including decisions about fluoride, but no studies exist on how intensive parenting attitudes influence topical fluoride opposition. The objective of this study is to investigate the association between intensive parenting attitudes and topical fluoride opposition. Methods. This was a secondary analysis of data on caregivers’ beliefs about fluoride for their children. An 85-item survey was administered from November 2020 to September 2021 (N=1,135). Participants were eligible if they were an English-speaking caregiver of a child under 18 years. The outcome variable was topical fluoride opposition, defined as how opposed the caregiver was to topical fluoride for their child (self-reported scale of 0-10). The explanatory variable was intensive parenting attitudes, defined as the extent of child-centered, time-intensive, and self-sacrificing parenting, measured as a composite score from three survey items. Linear regression was used to test the study hypothesis, adjusting for confounders. All analyses were performed in SPSS. Results. The meanÂ±SD caregiver age was 41.7Â±8.8 years, with most caregivers being women (73.0%), white (55.5%), non-Hispanic (79.3%), having greater than a 4-year degree (28.5%), and having private dental insurance (45.1%). The meanÂ±SD topical fluoride opposition score was 2.0Â±3.1, and the meanÂ±SD intensive parenting attitudes score was 1.7Â±0.4. After adjusting for confounders, a 1-point increase in intensive parenting attitudes score was associated with a 0.3-point increase in topical fluoride opposition score (95% CI: 0.1, 0.4; p<0.001). Conclusions. Intensive parenting attitudes were significantly and positively associated with topical fluoride opposition. Clinicians can utilize these findings to assess caregivers’ intensive parenting attitudes, learn about concerns, and address them by tailoring communication strategies to discuss appropriate risk-based recommendations about topical fluoride.
HIV Status Impact on Oral Health Related Quality of Life in 3- to 4-year-old Kenyan Children
(2025-08-01) Welter, Erin; Seminario, Ana Lucia
Purpose: This study investigates the impact of HIV status on oral health manifestations and oral health-related quality of life (OHRQoL) in Kenyan children aged 3 to 4 years old. Methods:360 children living in Kisumu County in West Kenya were enrolled in a longitudinal study with recruitment from 31 clinics and hospitals for patients: age 3- to 4-years-old at time of enrollment, with medical clearance, living in Kisumu County the next subsequent 12 months from enrollment, and with parent-caregiver consent. A nested cross-sectional study analyzed scores from Early Childhood Oral Health Impact Scale (ECHOIS) questionnaires given to those same childrens’ parent-caregivers. Equal-sized HIV status groups included: children HIV positive (HIV), exposed to but uninfected (HEU), and unexposed and uninfected (HUU). Parent-caregivers evaluated OHRQoL through nine child-focused questions across four domains: symptoms, function, psychology, and self-image/social interaction. Higher ECOHIS scores indicated a greater perceived negative impact on quality of life. Data was analyzed using descriptive statistics, t-test, and regression analysis (P<.05) for each group. Results: The total population demographics descriptive analysis showed: mean age of 3.4 years, females 51%, majority attending a private school 47% (no school 31%, public school 22%), and a majority live in a rural area 49% (urban 35%, peri-urban 16%). Significant differences were not detected between HIV status groups for all oral manifestations except for abnormal findings. However, the HIV group did have an increased prevalence of abnormal findings with 81% compared to the HEU group at 60% and the HUU group at 54%. The HIV group reported the lowest ECOHIS score (15%) compared to HEU (24.2%) and HUU (34.2%) in the Combined Child Function domain (p=0.003) Within that domain, the HIV group reported the lowest ECOHIS score (8.3%) compared to HEU (12.5%) and HUU (22.5%) for the specific question, Difficulty of drinking cold and hot beverages (p=0.006). Differences for other questions and domains were not statistically significant between HIV groups. Conclusion: Statistically significant findings were limited to the Child Function Domain and the specific question, Difficulty drinking hot or cold beverages, with lower ECOHIS scores in the HIV group. Further research is proposed to assess how life-threatening conditions like HIV influence parental-caregivers’ perception of the oral health and OHRQoL with a longitudinal study design.
Association of Liquid Biopsy Biomarkers with Survival Outcomes in Oropharyngeal Squamous Cell Carcinoma
(2025-08-01) Samady, Hedyeh; Chmieliauskaite, Milda
Background: Oropharyngeal squamous cell carcinoma (OPSCC) is increasingly associated with humanpapillomavirus (HPV) infection and often presents at advanced stages, contributing to substantial morbidity and mortality. Liquid biopsy offers a promising, non-invasive approach for cancer detection and monitoring; however, the prognostic significance of many reported biomarkers remains unclear. Objective: To systematically assess the prognostic relevance of liquid biopsy biomarkers in OPSCC using multi- omic data from The Cancer Genome Atlas (TCGA), and to evaluate their potential to complement established molecular markers. Methods: A systematic literature search identified diagnostic liquid-based biomarkers across molecular modalities, including DNA mutations, DNA methylation, gene expression, and miRNA expression. Biomarkers were mapped to TCGA OPSCC datasets, and their associations with overall survival were evaluated using univariate and multivariate Cox proportional hazards models, adjusting for HPV status, CDKN2A expression, and TP53/NOTCH1 mutations. Pathway enrichment analysis was conducted to explore biological relevance. Results: From 1,544 curated gene symbols corresponding to liquid-based biomarkers, 524 were significantly associated with worse overall survival in OPSCC (p < 0.05). DNA methylation markers near MIR21, VMP1, and KCNC1 exhibited the strongest prognostic performance (C-index > 0.69). Pathway enrichment analysis revealed that prognostic biomarkers were involved in key processes including extracellular matrix (ECM) organization, epithelial-mesenchymal transition (EMT), and oncogenic signaling via MAPK, Notch, and PI3K pathways. Importantly, 1,180 biomarkers provided independent prognostic value beyond established markers. Conclusion: This study demonstrates that a subset of liquid-based biomarkers holds strong prognostic value in OPSCC, independent of established molecular indicators. Integrating multi-omic biomarkers into liquid biopsy strategies may enhance risk stratification, support personalized treatment decisions, and improve monitoring of disease progression in OPSCC. Prospective validation is warranted to translate these findings into clinical practice.
Washington State Physicians’ Perceptions of Oral Medicine
(2025-08-01) Saleem Kashmiri, Wardah; Taylor, Stuart; Wong, Jacqueline
Background and AimsOral Medicine (OM) is the dental specialty devoted to the diagnosis and non-surgical treatment of complex oral and maxillofacial conditions. Oral medicine provides care for oral conditions typically not adequately addressed by their dentist, otolaryngologist or oral surgeon, as evidenced by frequent referrals to OM from these specialties. Physician education and training around oral and maxillofacial conditions is limited, potentially leading to missed diagnoses and fragmented care for patients with these conditions. To improve interdisciplinary collaboration, referral pathways, and medical education of oral conditions, it is important to understand physicians' awareness of OM. Therefore, this study aimed to assess levels of awareness and knowledge as well as referral practices and barriers, among medical physicians in Washington State with regard to the OM specialty. MethodsThis cross-sectional electronic survey study was conducted using REDCapÂ©. The survey was distributed to 23,336 licensed physicians in the state of Washington. Twenty-two questions captured five domains including demographics, awareness of and knowledge about OM, referral patterns and barriers. Quantitative data analysis was conducted using descriptive statistics. Open-ended responses were summarized. ResultsFive hundred eligible physicians completed the survey. Two hundred and sixty-eight (53.6%) participants reported prior awareness of OM. Nearly half of the participants (n=239, 47.8%) had >20 years of clinical experience, with family medicine (n=219, 43.8%) and internal medicine (n=164, 32.8%) comprising the specialties with the greatest number of participants. Nearly all (n=251, 93.7% and n=244, 91.0%) participants who were aware of OM correctly identified oral complications of cancer therapies and oral premalignant conditions, respectively, far fewer participants aware of OM (n=175, 65.3%) correctly identified medication related osteonecrosis as part of the OM scope of practice. Just more than half (n=166, 62.0%) of aware participants reported referring to OM providers. One hundred and thirty-five(50.4%) of these physicians made fewer than five referrals annually. Perceived barriers to collaboration included lack of awareness of OM (n=157, 58.5%), limited availability of OM providers (n=143, 53.3%), insurance issues (n=115, 42.0%), referral networks or systems (n=116, 43.2%), and perceived overlap with ENT and Dermatology (n=109, 40.6%). ConclusionThis study highlights critical gaps in medical physicians’ awareness and knowledge of OM, which may reduce access to adequate care for patients with oral conditions. Targeted educational initiatives, integration of OM content into medical curricula, and clearer referral pathways with increased availability of OM providers are possible methods to enhance physician knowledge of OM referrals and ultimately improve patient care. These findings support national efforts to increase medical-dental collaboration and emphasize the oral-systemic health connection, promoting a less segmented healthcare model.
Perceived Knowledge, Attitude and Practice of Dental Students at University of Washington School of Dentistry Regarding the Diagnosis and Management Strategies of Temporomandibular Disorders.
(2025-08-01) Kaur, Amarinder; Sotak, Nicholas
BACKGROUND:-Temporomandibular Disorders (TMD) represent a group of conditions that impact the temporomandibular joint (TMJ), the muscles of mastication, and associated structures, frequently resulting in pain, dysfunction, and diminished quality of life. TMD is prevalent in the global population with up to 10% of individuals exhibiting symptoms. Despite its common occurrence, the diagnosis and treatment of TMD is difficult due to the disorders’ complex nature which encompass both physical and psychosocial elements. Dental students are trained to recognize the clinical manifestations of TMD, evaluate potential etiologies, and propose suitable therapeutic approaches during their dental education. The perceived knowledge, attitude, and practice (KAP) of dental students concerning TMD is a vital area of investigation to help assess their preparedness to manage the disorder in clinical settings.  Objectives: To evaluate the level of perceived knowledge of dental students regarding the causes, clinical presentation, and diagnosis of TMD. To determine the attitude of dental students towards diagnosing and treating TMD in clinical practice. To determine the anticipated practices of dental students towards diagnosing and treating TMD in future clinical practice. Methods: Anonymous self-administered cross-sectional survey with closed and open-ended questions which included all 3rd and 4th year University of Washington dental students who had completed at least 6 months of clinical training and at least 2 quarters in a clinical clerkship that trains students in the diagnosis and management of TMD. Results: The survey was conducted between 3rd and 4th year dental students. Seventy-five out of 145 recruited students responded to the survey. It was observed that 82.7% students self-reported understanding of the potential causes and risk factors of TMD and 86.7% reported ability to recognize the common symptoms associated with TMD.Nearly 94.7% believed that patients with jaw, face or neck pain should be screened for TMD, 96% believed TMD has a negative impact on patients’ quality of life, and 81.3% believed that TMD represents a public health concern. Conclusion: This study indicates that dentistry students at the University of Washington display a high perceived knowledge and predominantly consistent attitude towards the management of temporomandibular disorders; however, students expressed only modest perceived expertise in TMD management likely indicating constrained clinical confidence.
Oral Health Documentation in a Pediatric Cancer Unit at a Children’s HospitalÂ
(2025-08-01) Chavez, Amarina; Velan, Elizabeth
Purpose: Patients hospitalized for cancer and blood disorders have an elevated risk of infection due to immunosuppression during treatment. Damaged oral mucosa can be a direct entry for bacteria and fungus, leading to bloodstream and systemic infections. Oral care documentation measures are essential to understanding and improving oral hygiene practices among these high-risk patients. This quality improvement project aimed to increase oral care documentation among patients hospitalized in the Cancer and Blood Disorders Center (CBDC) to support infection prevention efforts. Methods: An interdisciplinary group of healthcare providers developed and implemented interventions to improve oral care documentation. The dental team developed educational materials for families and certified nursing assistants (CNAs) to improve knowledge and behavior around oral care documentation. The documentation rate for the pre and post intervention groups was analyzed. Results: Forty-seven CNAs (87%) completed the post-education oral care questionnaire. Among them, 33 CNAs (70%) reported using the 3-2-1 poster and encouraging families to use hygiene reminder tools. Fifteen CNAs (32%) indicated they chart oral care twice per shift. Post-intervention data showed a statistically significant improvement in oral care documentation (P = .042); however, overall documentation remained low, with a median rate of 4.3%. Conclusions: Improving oral care documentation requires sustained, systemic changes and long-term interdisciplinary collaboration. While targeted interventions showed some improvement, consistent effort is needed to achieve meaningful and lasting outcomes.
Association Between Caregiver Opposition to Topical Fluoride and Dental Radiographs
(2025-08-01) Lee, Kerry Hope O'Bannon; Nelson, Travis
Purpose: The primary objective of this study was to examine the association between caregiver opposition to topical fluoride and opposition to dental radiographs. The secondary aim was to identify reasons for dental radiograph opposition. Methods: The study was conducted at six pediatric dentistry clinics, all affiliated with universities or hospitals. English-speaking caregivers of children aged < 18 years were eligible to participate. A 108-item web-based survey was administered from February to November 2024. The predictor variable was topical fluoride opposition (no/yes) and the outcome was dental radiograph opposition (no/yes). Confounder-adjusted logistic regression models were used to assess the association. Results: Nine-hundred-sixty-nine caregivers were included in the study. Mean child age was 7.4 years (SD 4.19), mean caregiver age was 40.6 years (SD 8.29), 81% of caregivers were female, 53% self-reported as white, and 56% were insured by Medicaid. Thirty-eight percent of caregivers were opposed to topical fluoride, and 31% were opposed to dental radiographs. There was a significant positive association between topical fluoride opposition and dental radiograph opposition (Odds Ratio = 7.04, 95% CI: 4.72-10.65, p < 0.001). The top three reasons for dental radiograph opposition were concerns about unknown future harm (58%), radiation accumulation (51%), and cancer risk (47%). Conclusions: Caregivers opposed to topical fluoride were significantly more likely to oppose dental radiographs for their child, emphasizing the need for targeted interventions and education focusing on common reasons for opposition.
The Role of Slc20a2 in Osteogenesis
(2025-08-01) Walczak, Philip Adam; Giachelli, Cecilia M
The role of inorganic phosphate transporters at the bone surface remains largely unknown. Prior work has established that Slc20a2, which encodes type III sodium-dependent phosphate transporter PiT-2, plays a crucial anti-calcific role in both vascular and brain tissues and physiologic osteogenesis. This work investigates Slc20a2 expression in bone cells and explores the mechanisms that lead to impaired osteogenesis when Slc20a2 is lost. Tibia samples were collected from C57Bl6/J and C57Bl6/J CD-1 outbred mice carrying the EUCOMM tm1a knockout-first cassette. Whole-tissue X-Gal staining identified Slc20a2 localization to a bone-lining adjacent cell type. Publicly available single-cell RNA-seq (scRNA-seq) datasets were analyzed to corroborate expression signatures across different bone cell populations. To examine gene expression changes in situ, a demineralization protocol was optimized to preserve RNA. Subsequently, spatial transcriptomics (Nanostring GeoMx DSP and 10X Genomics Visium HD) was performed on demineralized bone sections, and immunofluorescence studies further validated the identity of various vascular and bone cell types. Finally, SPiDER-βGal (Dojindo) was employed to sort LacZ-expressing cells from heterozygous and knockout mice, enabling mRNA-seq to confirm their specific identity. Early observations in dental tissues also provided insight into Slc20a2 localization and its effects on mineralization. Key findings indicate that Slc20a2 deficiency impairs osteoblast numbers and function. X-Gal staining localized Slc20a2 to bone-lining cells between marrow vasculature and osteoblasts, suggesting a bridging position between osteoblasts and blood vessels. scRNA-seq data showed Slc20a2 expression is highest in CXCL12-abundant reticular cells, specifically osteo-CAR cells. Additional markers, including Limch1 and KCNK2, co-localized with X-gal staining, validating these observations. Spatial transcriptomic approaches confirmed the cell-specific marker expression in carefully defined regions of interest, and RNA-seq of sorted Slc20a2-deficient LacZ-expressing cells further supported these findings. Moreover, Slc20a2 loss resulted in defective molar mineralization and heightened susceptibility to incisal wear or fracture. Notably, the inner and outer enamel epithelia—especially the stratum intermedium—showed robust Slc20a2 expression. Overall, this work reveals that Slc20a2 is highly expressed in osteo-CAR cells at the endosteal–bone marrow interface, a population that may regulate osteogenesis either by signaling cues or by providing a reservoir of pre-osteoblasts. These insights offer a novel perspective on how inorganic phosphate regulation and Slc20a2 expression could be leveraged in clinical settings to address bone disorders such as osteoporosis.
Obstructive Sleep Apnea: A Summary of Clinical Practice Guidelines and the Adherence by Airway Focused Dentists and Orthodontists
(2025-05-12) Mustafa, Mariam; Bayirli, Burcu B.B
Introduction: The first aim of this study was to determine the published clinical guidelines regarding the involvement of dental professionals in screening, diagnosis, and treatment of Obstructive Sleep Apnea (OSA). The second aim was to determine whether airway focused dentists and orthodontists were adhering to published guidelines regarding their roles in the screening, diagnosis, and treatment of OSA. Methods: A summary of published guidelines for screening methods and treatment modalities was collated and those endorsed by 50% or more of the sources were considered the common guidelines. A survey was sent to airway focused general dentists (AFD), airway focused orthodontists (AFO) and non-airway focused orthodontists (non-AFO) to enquire about their practices for screening, diagnosis, and treatment of OSA. The results of the survey were then compared to the common clinical guidelines and the three groups of participants were compared to one another. Results: Various professional organizations published guidelines on the methods for screening, diagnosing, and treating patients for OSA. The common guidelines recommended screening patients for OSA and then, referring to a sleep physician for diagnosis and treatment planning, when screening yields positive risk of OSA. Importantly, there were no clinical guidelines for preventing OSA. Some variation existed across the guidelines, including details of screening methods and treatment modalities. There was a response from 48 AFD, 41 AFO, and 78 non-AFO. Airway focused dentists and AFO screened and offered treatment for OSA at a higher frequency than non-AFO. Both AF dentists and orthodontists used radiographs for screening at a higher frequency than non-AFO. Additionally, AFD and AFO offered treatment to prevent and cure OSA. Airway focused dentists referred for tonsillectomy to prevent OSA at a significantly lower frequency that AFO, and AFD utilized maxillomandibular surgery and adenotonsillectomy at a lower frequency than AFO to cure OSA. Approximately half of AFD and AFO occasionally treated patients for OSA in collaboration with a sleep physician. None of the AFD completely adhered to the common guidelines for the steps taken from screening to treating patients for OSA. One AFO and one non-AFO completely adhered to the common guidelines for the above. Conclusions: Clinical guidelines from professional organizations on the management of OSA generally agree on the principles regarding screening, diagnosing, and treating OSA; however, they differ in some methods which may result in variations in the behavior of dentists and orthodontists. Few AFD and AFO consistently adhere to common guidelines for screening, treating, and practicing in collaboration with sleep physicians. Airway focused dentists and AFO provide preventative treatment which is not supported by the common guidelines.
Facial Symmetry Outcomes in Craniofacial Microsomia after Growth Monitoring, Corrective Sur-gery, and Orthodontic Treatment
(2025-05-12) Lander, Daniel James; Sheller, Barbara
Background: Craniofacial Microsomia (CFM) is a congenital malformation syndrome affecting craniofacial structures derived from the first and second pharyngeal arches. It presents with varia-ble degrees of chin point deviation, mandibular hypoplasia, facial asymmetry, ear anomalies, and soft tissue deficiencies, making classification and treatment challenging. The Kaban classification systems is commonly used to assess severity and guide treatment.Objective: This study evaluates facial symmetry and occlusal outcomes in patients with CFM following staged growth monitoring, surgical interventions, and orthodontic treatments, using the Phenotypic Assessment Tool – Craniofacial Microsomia (PAT-CFM) tool and conventional orthodontic measures. Methods: A single-center retrospective cohort study was conducted at Seattle Children's Hospital Craniofacial Center. Data from 130 patients with CFM were reviewed, with 74 subjects meeting inclusion criteria based on imaging at multiple time points. Growth monitoring outcomes, surgical interventions—including costochondral grafting (CCG), orthognathic surgery, and orthodontic treatments were analyzed to determine their impact on facial asymmetry and occlusion. Results: Forty-five patients with mild CFM (Kaban I and IIa) showed stable or improved chin point deviation, mandibular hypoplasia, and occlusal plane canting over a mean growth period of 4.6–6.0 years. In fifteen moderate to severe subjects (Kaban IIb and III), CCG, orthognathic sur-gery, and/or orthodontic treatment resulted in improved mandibular morphology and occlusal plane alignment, though outcomes varied. Orthognathic surgery combined with orthodontics significantly enhanced facial symmetry and occlusion in severe cases. Conclusion: Data indicated that mild CFM remains stable or improves with growth, while surgical and orthodontic interventions play a crucial role in managing moderate to severe cases. Comprehensive treatment strategies, including CCG and orthognathic surgery, result in improved facial symmetry and occlusal outcomes.
Comparison of Outcomes in Adolescents Treated with Aligners versus Fixed Appliances in an Academic Setting
(2025-05-12) Oki, Dayton; Huang, Greg J
Background: Adolescents are increasingly requesting and being treated with aligners, and there is a need for better information regarding treatment indications and outcomes in this population. Purpose: The aims of this study were to compare treatment efficacy and efficiency, presence and extent of new or larger white spot lesions (WSL), and oral health-related quality of life (OHRQOL) in adolescent patients treated with aligners versus fixed appliances (FA) in an academic dental clinic. Study Design: This cohort study was carried out in the University of Washington (UW) Graduate Orthodontics clinic. 29 adolescent subjects (18 male and 11 female, mean age = 14) treated with aligners and fulfilling the inclusion criteria were recruited and matched 1:1 with adolescent subjects treated with FA. Pre-treatment characteristics were collected, and subjects were contacted to complete a modified OHIP-14 questionnaire to evaluate their OHRQOL. Treatment efficacy was assessed by comparing the peer assessment rating (PAR) scores and treatment efficiency was assessed by comparing the number of emergency visits, de-bonded appliances, appointment visits, and treatment time. Presence and extent of new or larger WSLs were assessed evaluating the incisors from the digital photos using the ImageJ software. Results: The two groups had similar demographic and pre-treatment parameters, as well as post-treatment PAR scores. There was a trend for less de-bonded appliances in the aligner group (mean A = 1.0 vs. FA = 3.0 appliances; p = 0.07), but no significant difference in the treatment time. However, participants in the aligner group had significantly less treatment visits (mean A = 15.7 vs. FA = 21.3 visits; p < 0.001) and emergency visits (mean A = 0.4 vs. FA = 1.0 visits; p = 0.01). Participants in the aligner group had significantly fewer maxillary incisors with new or larger WSLs (p = 0.02), and oral hygiene counselling was provided three times less frequently (p = 0.01) compared to participants in the FA group. Lastly, the groups had similar total OHIP-14 scores, but only 26% of participants in the aligner group reported occasional interruption of meals versus 70% of participants in the FA group (p = 0.02). Conclusions: This study found both groups had similar PAR outcomes and treatment times. However, participants in the aligner group had fewer emergency visits, treatment visits, de-bonded appliances, new or larger WSLs, and interruption of meals compared to participants in the FA group.
Alveolar Bone Height Preservation in Growing Patients After Decoronation, Extraction, or Retention of Ankylosed Primary Teeth: A Retrospective Cohort Study
(2025-05-12) Cohanim, Sophia; Woloshyn, Heather
Introduction: Mandibular second premolars are frequently congenitally missing. Preservation of the alveolar ridge to facilitate future implant placement is critically important for favorable outcomes. Maintaining the retained primary tooth is desired unless the primary tooth becomes ankylosed during the growth period. This study examined three approaches to preserving alveolar bone height in growing patients when the retained primary tooth becomes ankylosed: decoronation, extraction, or retention of the tooth. We hypothesized that decoronation would show the greatest preservation of bone height, while retention would show the least. Methods: This retrospective cohort study used de-identified serial radiographs collected from practitioners in the greater Seattle-Tacoma area. Ankylosed primary mandibular second molars with congenitally missing mandibular second premolars were separated into three groups based on management method: decoronation, extraction, or retention. Alveolar bone height was measured at two time points and the change over time was calculated. Results: The mean age of each sample in years at T0 was 13.1, 13.6, and 12.6 for decoronation, extraction, and retention, respectively. The mean follow-up time in months for each sample was 22.9, 29.1, and 23.9 for decoronation, extraction, and retention, respectively. Decoronation of ankylosed mandibular primary second molars showed the most favorable change in alveolar bone height over time, with the bone height in the region either increasing or remaining stable. Retention showed the least favorable effect, with alveolar bone height decreasing as the patient matured. Extraction displayed an intermediate response. Conclusions: The alveolar ridge responds more positively during growth after decoronation in patients with ankylosed primary second molars. Growth may influence the extent of change observed in each group.
Orthodontists' Awareness of the Radiation Dose of Cone Beam CT Scans (CBCT) in Orthodontics and Its Influence on the Use of CBCT
(2025-05-12) Amintavakoli, Niloufar; Bollen, Anne-Marie AMB
The purpose of this study was to evaluate the use of cone beam computed tomography (CBCT) by orthodontists in the USA and the orthodontists' awareness of the radiation dose of cone beam CT scans compared to 2D radiographs. A survey was developed using the Qualtrics platform and disseminated to orthodontists practicing in the US. A second survey was distributed amongst the orthodontics post graduate program directors to report the use and training on CBCT scans during orthodontic programs. From the 161 orthodontists who responded to the first survey, almost half of them indicated that they use CBCT scans routinely. 47% reported that they believe that the CBCT scans have equal or lower radiation than a combination of the traditional 2D radiographs (panoramic plus cephalometric radiograph). Not providing additional information (42.2%) was the most common reason preventing orthodontists from prescribing CBCT scans followed by lack of access (34.8%), radiation (33.5%), cost (27.3%), never prevented (26.1%), insurance (13%), patient being child/adolescent (11.8%). From the 15 program directors who responded to the second survey, 53.3% indicated that they have direct access to a CBCT scan in the graduate orthodontic clinic and 46.7% indicated that they refer their patients to another clinic. 13.3% indicated that they use a CBCT scan on 100% of all their patients. The most common number of hours of training on radiation safety was 1-2 hours (46.2%) was followed by 3-5 hours (38.5%) and none (15.4%). The lack of clinicians' knowledge of radiation exposure, as well as their reported limited training in CBCT use suggest that there is a pressing need for enhanced education regarding CBCT radiation safety.

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