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  1. Alhafi ZM, Hajeer MY, Burhan AS, Latifeh Y, Ajaj MA, Almusawi AOA, et al.
    Cureus, 2024 Dec;16(12):e76179.
    PMID: 39711937 DOI: 10.7759/cureus.76179
    Background and objectives A modified aligner appliance with nickel-titanium springs (MAA) is a relatively new appliance that has not received extensive attention in orthodontics. This study evaluated the patient-reported outcomes when orthodontic treatment was provided using a modified aligner appliance to treat mild lower incisor crowding. Materials and methods This prospective cohort study consisted of 42 patients (11 males and 31 females; mean age 21.69 ± 2.56 years) with mild crowding. Twenty-one patients were treated using a modified aligner with nickel-titanium springs, while the remaining patients were treated with a conventional fixed orthodontic appliance (FA). Patient responses regarding pain, discomfort, and difficulty in chewing, swallowing, and speaking were recorded using a visual analog scale (VAS) at six assessment times: 24 hours (T1), two days (T2), three days (T3), two weeks (T4), one month (T5), and two months (T6) after appliance application. Results The mean perceived pain and discomfort levels were generally lower in the traditional fixed appliance (FA) group than the modified aligner appliance with nickel-titanium springs group at most assessment times. However, no statistically significant differences were found between the two groups. Chewing difficulty levels were similar between the two groups with no substantial differences. Swallowing and speech difficulty were significantly higher in the MAA group compared to the FA group during the first two days of treatment (P < 0.008). Conclusions Patients using both types of orthodontic appliances experienced temporary discomfort, including pain and difficulty chewing. While the modified aligners appliance with nickel-titanium springs caused additional challenges with swallowing and speaking, these issues were resolved over time, allowing patients to adjust to the treatment.
  2. Albitar MA, Burhan AS, Hajeer MY, Aljabban O, Ajaj MA, Nawaya FR, et al.
    Cureus, 2025 Jan;17(1):e77021.
    PMID: 39764478 DOI: 10.7759/cureus.77021
    BACKGROUND: Soft tissue specifications and facial values ​​vary depending on the underlying skeletal structures. To achieve the ideal treatment result and patient satisfaction, one must know the attractive soft tissue specifications compatible with each type of malocclusion. This study aims to analyze the facial measurements that contribute to perceived facial attractiveness in patients with vertical growth patterns and skeletal class I malocclusion, focusing on gender-specific differences.

    METHODOLOGY: A panel of 30 laypersons, including raters from both genders equally, aged 19-24 years, evaluated extraoral photographs taken before the treatment of 60 patients (evenly divided between males and females employing a disproportionate stratified sampling method through a computer-generated list) with skeletal class I malocclusion, vertical growth pattern based on the Bjork sum, aged 18-25 years (with an average age of 22 ± 1.53 years), with the photographs taken in three positions (frontal relaxed, frontal during a smile, and relaxed profile). The raters utilized the visual analog scale (VAS) to assign an esthetic quality score to each photograph. Based on the average esthetic scores of each photo, two groups were created: the most attractive group, which received the highest esthetic score, and the least attractive group, which received the lowest esthetic score. After selecting 12 patients for each group, the angles and proportions of the frontal and lateral photos were calculated, and the results were compared between the two groups using an independent-sample t-test to see any significant differences.

    RESULTS: The most attractive females had a significantly lower value of mouth width to lower facial height than the least attractive females (P = 0.039). In addition, the most attractive males had a substantially greater value of facial convexity angle than the least attractive males (P = 0.041). Regarding other profile and frontal variables, no statistically significant differences existed between the most and least attractive males and females.

    CONCLUSIONS: In patients with vertical growth pattern malocclusion, it is important to consider the chin protrusion of male patients during treatment planning and diagnosis because it enhances masculine features in these patients, as well as the lower facial height of female patients.

  3. Shaadouh RI, Hajeer MY, Burhan AS, Ajaj MA, Jaber ST, Zakaria AS, et al.
    Cureus, 2023 Oct;15(10):e48064.
    PMID: 37920628 DOI: 10.7759/cureus.48064
    Malocclusion may affect interpersonal relationships, self-esteem (SE), and psychological well-being, weakening patients' psychological and social activities. Several studies investigated the effect of orthodontic treatment on these social and psychological aspects, such as SE. However, the direct relationship between SE and orthodontic treatment has not yet been confirmed. This systematic review aimed to evaluate the existing evidence in the literature concerning the influences of orthodontic treatment on patients' SE systematically and critically. An electronic search in the following databases was done in September 2022: PubMed®, Web of Science™, Scopus®, Embase®, GoogleTM Scholar, Cochrane Library databases, Trip, and OpenGrey. Then, the reference list of each candidate study was checked for any potentially linked papers that the electronic search might not have turned up. Inclusion criteria were set according to the population/intervention/comparison/outcome/study design (PICOS) framework. For the data collection and analysis, two reviewers extracted data separately. The risk of bias 2 (RoB-2) and the risk of bias in non-randomized studies (ROBINS-I) tools were used to assess the risk of bias for randomized controlled trials (RCTs) and non-RCTs, respectively. The grading of recommendations assessment, development and evaluation (GRADE) approach was employed to evaluate the quality of the evidence for each finding. Sixteen studies (five RCTs, seven cohorts, and four cross-sectional) were included in this review. Unfortunately, the results could not be pooled into a meta-analysis. Only six studies have reported an increase in SE after orthodontic treatment (P<0.05 in these studies). No agreement between the included studies was observed regarding the influence of fixed orthodontic treatment, gender, or age on SE. The quality of evidence supporting these findings ranged from very low to low. There is low evidence indicating that fixed orthodontic treatment can improve patients' SE. In addition, unclear data are available about the influence of patients' gender and age on SE after orthodontic treatment. Therefore, high-quality RCTs are required to develop stronger evidence about this issue.
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