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Open research questions in Orthodontics and Dentofacial Orthopedics

242 unresolved questions extracted from the limitations and future-work sections of 9,373 Orthodontics and Dentofacial Orthopedics papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • Background/Objectives: Automatic three-dimensional (3D) cephalometry on cone beam computed tomography (CBCT) is increasingly used in orthodontic and orthognathic practice, but whether fully automatic systems reproduce bilateral measurements with equal fidelity on both sides, and whether the right–left difference they report can be trusted as a clinical measure of asymmetry, has not been studied systematically.

    Left–Right Consistency and Quantification of Craniofacial Asymmetry by Two Fully Automatic AI-Powered Three-Dimensional Cephalometry Systems on CBCT · 2026 · DOI

  • this limitation, It is essential to acknowledge a limitation of the present study, precisely the response rate of 10. Personalized invitations or alternative communication methods could be explored to reach a broader spectrum of orthodontists, thus enriching the dataset and contributing to a more comprehensive understanding of prevailing trends.

    A survey on clear aligner treatment: perspectives of orthodontists and orthodontic specialty / PhD students · 2026 · DOI

  • This study showed that the occurrence of Class II malocclusion and Bimaxillary protrusion in the Nigerian population is quite high. More emphasis should be placed on preventive and interceptive orthodontics in order to reduce it to the barest minimum. 2. Government should provide further assistance to the health sector and enhance training of more orthodontists to cope with treatment demands.

    Cephalometric Findings In Pre-Treatment Orthodontic Patients In A Teaching Hospital · 2026 · DOI

  • Several limitations should be acknowledged. Treatment accuracy is influenced by patient-, laboratory-, and mea- surement-related factors. Differences in aligner material and thickness (PET-G 0.5–0.75 mm vs multilayer poly- urethane 0.75 mm) may alter force delivery and biome- chanical responses [6, 31–33]. The bite-block effect of aligners and the use of hybrid mechanics likely contrib- uted to differential vertical molar changes between full IHCA and hybrid protocols [34–36]. Measurement error arising from scanning, software processing, 3D printing may also have affected precision [26]. Another limitation is the use of palatal rugae for digi- tal model superimposition, which can remodel during anterior retraction [37–39]. Without skeletal anchor- age (e.g., TADs), posterior teeth may not remain sta- tionary, potentially affecting the accuracy of the best-fit superimposition. Finally, patient compliance remains a critical determi- nant of the achieved clinical outcomes [27]. Although the prespecified equivalence margins were clinically justified, they are inherently context dependent. While adequately powered for the primary outcome, the study may have been underpowered to demonstrate equivalence for angular movements with greater variabil- ity. The analysis focused on mean paired differences and did not account for potential effect modifiers (e.g., tooth morphology, attachment design, biological responsive- ness). The Holm step-down procedure, although appro- priate for multiplicity control, increased the stringency of equivalence testing and may have led to conservative conclusions for outcomes near the equivalence bounds. Future research suggestions include prospective clini- cal studies with larger sample sizes, using various aligner materials and wearing protocols, and incorporating 3D cone-beam computed tomography in the aligner setup Page 15 of 17 and superimposition process for greater precision to achieve a more comprehensive understanding of IHCA.

    Accuracy of final canine retraction with and without a palatal power arm using in-house clear aligners: a randomized clinical trial · 2026 · DOI

  • Moreover, the posterior displacement of the MF with increasing age may offer valuable insights into mandibular growth rate variability, a hypothesis warranting further exploration.

    Age-related variations in the location of the mental foramen: a retrospective panoramic radiographic study in children · 2026 · DOI

  • Long-term evaluation of treatment results with aligners using mandibular advancement feature needs to be studied to prove that CAMA provides an enhanced experience of comfortable care better than conventional appliances, that are still relevant. The confounding effect of natural growth is a significant limitation when interpreting the observed skeletal changes.

    Assessment of short-term skeletal and dental effects of mandibular advancement with aligners in class II patients · 2026 · DOI

  • This study has several limitations. The sample size was modest, and the 16-week observation period may not fully capture long-term treatment behavior or post-treatment stability. The absence of cone-beam computed tomography limited differentiation between skeletal and dentoalveolar components of expansion, restricting interpretation primarily to dental changes. Because only skeletally mature adults were included, extrapolation to growing or mixed-dentition populations should be made with caution. Additionally, exclusion of participants with documented non-compliance may have introduced selection bias, as the reported expansion accuracy reflects outcomes under controlled adherence conditions and may not fully represent real-world variability in aligner wear. Although digital models provide high- dimensional accuracy, they do not permit direct assessment of alveolar bone remodeling or cortical plate adaptation. Future multicenter investigations incorporating larger cohorts and volumetric imaging modalities are warranted to enhance generalizability and further elucidate the relative dental and skeletal components contributing to aligner- mediated transverse changes.

    Assessment of the Accuracy of Clear Aligner Therapy for Maxillary Expansion: A Prospective Clinical Study · 2026 · DOI

  • Retrospective design, limited sample size, variable follow-up rates, lack of randomization are some of the limitations in this study. However, to overcome few of these limitations, we had included participants with complete data, matched treated and control group with respect to age, sex and skeletal maturity and enumerated all the patients to increase the power of the study.

    Cephalometric Study of the Effect of “Maxillary Splint with High Pull Headgear” for the Treatment of Class II Division 1 Malocclusion – A 12–18 Months Retrospective Matched-Control Study · 2026 · DOI

  • There are a few limitations to note. Its retrospective design reduces control over potential confounders. Group allocation was based on patients’ individual preference for or against fixed retention, which represents a sub- stantial source of selection bias: patients declining fixed retainers may differ systematically from those accepting them with respect to compliance behavior, oral hygiene attitudes, or socioeconomic factors; characteristics that are likely to influence removable retainer wear adherence as well. This potential confounding by indication limits causal interpretation of the observed stability differences between the two groups. Furthermore, compliance with removable retainers could not be objectively verified, which represents an inherent limitation of all remov- able retention systems, as wear adherence is ultimately dependent on patient behavior and cannot be controlled irrespective of study design. Importantly, this compli- ance dependency is not a methodological shortcoming of the present study but reflects a characteristic of remov- able appliances. Therefore, the independence from patient cooperation represents a fundamental advantage of fixed retention over removable appliances. In addition, because group 1 includes multiple fixed retainer designs under a single exposure category, the primary fixed-versus- removable comparison reflects a mixed protocol; readers should interpret it accordingly. Although three-dimensional superimposition enabled detailed quantification of tooth movements, distinguishing relapse from retainer-associated effects was not always pos- sible. Vertical changes should also be interpreted with cau- tion, as superimposition on molars and premolars may cause physiological settling to appear as relative anterior displace- ment. Furthermore, different retainer types were included and analysed, however, subgroup comparisons were limited by sample size. Larger studies are needed to enable mean- ingful comparisons. Finally, the follow-up period reflects short- to mid-term retention, and longer observation is required to assess long-term stability.

    Three-dimensional stability during orthodontic retention: A comparative analysis of conventional, CAD/CAM-fabricated, and robotically bent fixed retainers versus removable appliances · 2026 · DOI

  • Future research should focus on the development of biodegradable or recyclable aligner materials without compromising clinical performance [2,8]. Life cycle assessment studies are required to evaluate environmental impact across all stages of aligner therapy [1,5]. Implementation of circular economy models, including aligner recycling and take-back programs, is recommended [6,9]. Advancements in 3D printing technology should aim to reduce resin waste and improve sustainability [3]. Policy development and educational initiatives are essential to promote environmentally responsible orthodontic practices [4,9].

    Environmental Impact of Clear Aligner Therapy: Addressing the Hidden Burden of Plastic Waste in Modern Orthodontics · 2026 · DOI

  • Despite its strengths, this study has several limitations that should be considered when interpreting the findings. First, the cross-sectional design limits the ability to establish causal relationships between demographic variables and patterns of partial edentulism. The observed associations should therefore be interpreted as correlational rather than causal. Second, the study was conducted in a single tertiary care institution using a hospital-based convenience sample. As a result, the findings may not be fully generalizable to the broader community or rural populations, particularly those who do not seek regular dental care. Selection bias may therefore have influenced the distribution of observed patterns. Third, certain variables, such as duration of edentulism and socioeconomic status, were based on self-reported data, which may introduce recall bias or reporting inaccuracies.

    Frequency of Patterns of Partial Edentulism in Maxillary Arch in Patients Reporting to the Department of Prosthodontics, Bacha Khan College of Dentistry · 2026 · DOI

  • Author contributions Several limitations should be acknowledged. First, the study population consisted of patients undergoing orthognathic surgery combined with orthodontic treatment, and substantial inter-individual variation may exist within each skeletal class. Second, vertical skeletal patterns were not analyzed because of the limited sample size within each anteroposterior group. Third, the mid-sagittal plane was defined using nasion and crista galli; however, deviation of the crista galli is common and may have affected measurement accuracy. YS: Writing – review & editing, Software, Writing – original draft, Visualization, Conceptualization, Investigation, Formal analysis, Project administration, Data curation, Methodology. SKo: Writing – original draft, Formal analysis, Supervision, Methodology, Writing – review & editing. SKu: Data curation, Writing – original draft, Software, Writing – review & editing, Visualization. SN: Writing – review & editing, Methodology, Supervision, Writing – original draft, Funding acquisition.

    CT-based three-dimensional morphometric analysis of the bony palate and hard palatal mucosa in female orthognathic surgery candidates · 2026 · DOI

  • Conclusion: Within the conditions and limitations of this study, the effect of the CM - combined with the addition of retro-palatal canine bite - on the correction of Class II subdivision malocclusions appears to be dentoalveolar.

    Effet du Carriere Motion associé à des cales palatines canines sur la malocclusion de classe II subdivision chez l’adulte : une étude rétrospective · 2025 · DOI

  • The use of adjunctive facial implants-made from materials such as porous polyethylene, titanium, or polyetheretherketone (PEEK)-has increased to enhance contour and projection, although standardized guidelines for their selection and integration remain scarce.

    Facial Contouring in Orthognathic Surgery: The Role of Facial Implants · 2025 · DOI

  • CONCLUSION: A more inferior initial hyoid position was associated with limited mandibular advancement, suggesting a potential anatomical link to airway physiology, warranting further investigation into its implications for OSA risk.

    The role of the hyoid bone in mandibular advancement: insights from functional appliance therapy in patients with skeletal class II – a prospective cohort study · 2025 · DOI

  • Most clinical studies of natural dentitions determined that GF occurs more commonly than CPA but there is a lack of data supporting the superiority of either of these two eccentric occlusal relationships.

    What occlusal scheme should be used for tooth‐supported fixed partial dentures? · 2025 · DOI

  • Conclusion: Within the limitations of this study such as the small sample size and the pilot nature of the study, it can be concluded that the facial proportions of the Indian population belonging to the Indo-Ariyan and Dravidian races differed considerably when analyzed and compared with one another.

    Analysis and comparison of esthetic faces between Indo-Ariyan and Dravidian races of Indian population: An anthropometric study · 2025 · DOI

  • Dolphin Imaging’s Visual Treatment Objective (VTO) module simulates soft tissue changes, but its predictive accuracy after FFA therapy remains uncertain, especially across sexes.

    Gender-based Comparison of Prediction Accuracy in Soft-tissue Cephalometric Variables Post Fixed-functional Appliance Therapy Using Dolphin VTO Software · 2025 · DOI

  • evaluations. For functional (Q1–Q18), the mean score significantly decreased from 2.57 to 1.30 (p=0.021p = clear 0.021p=0.021), improvement in overall functionality. This significant the effectiveness of the intervention in reducing perceived limitations. indicating suggests change a significant In the domain of physical pain (Q9– Q22), the mean score decreased from 2.49 to 1.24; however, this difference was not (p=0.067p = statistically 0.067p=0.067). While the change suggests a tendency towards improvement, the lack of statistical significance implies that the results cannot be conclusively attributed to the intervention. For physical disability (Q23–Q32), the mean score decreased from 2.23 to 1.33, but this change was not significant (p=0.310p = 0.310p=0.310), indicating that this change did not In the handicap domain (Q44–Q49), the mean score decreased from 1.61 to 1.11; reach however, statistical significance (𝑝=0.097). While the values suggest an improvement in the general perception of handicap, the difference is not pronounced enough to be deemed statistically significant. Overall, the results indicate more pronounced improvements in certain domains, while other areas showed changes that were not statistically significant.

    STUDY ON THE QUALITY OF LIFE IN PATIENTS WITH DENTO-MAXILLARY ANOMALIES TREATED USING THE "SURGERY FIRST" APPROACH · 2025 · DOI

  • Clarifying the controversies surrounding the success and failure rates of RPE, MARPE, and SARPE through advanced CBCT analysis is fundamental to creating adapted, patient-specific guidelines.

    TOWARDS AN EVIDENCE-BASED PROTOCOL FOR MAXILLARY EXPANSION: THE CRITICAL IMPORTANCE OF MIDPALATAL SUTURE MATURATION · 2025 · DOI

  • Evidence-based protocols are essential to guide clinicians in choosing the most appropriate expansion method (RPE, MARPE, or SARPE) for each patient, considering midpalatal suture maturation stages.

    TOWARDS AN EVIDENCE-BASED PROTOCOL FOR MAXILLARY EXPANSION: THE CRITICAL IMPORTANCE OF MIDPALATAL SUTURE MATURATION · 2025 · DOI

  • Moreover, as the root apices of the maxillary anterior teeth are much closer to the labial side in Class I and Class II malocclusion, the range of movement at the root apex should be limited to avoid extensive labial movement.

    Three-dimensional analysis of the positional relationship between the dentition and basal bone region in patients with skeletal Class I and Class II malocclusion with mandibular retrusion · 2024 · DOI

  • Conclusions: While there were only a limited number of significant sexually dimorphic correlations between the digit and incisor ratios for non-White participants, the results obtained suggest further investigation of possible relationships between the sexually dimorphic digit ratios and odontometric ratios other than central to lateral incisors.

    No correlation between sexually dimorphic ratios of the sizes of fourth to second digits and hypothesized ratios of the sizes of the central to lateral incisors · 2024 · DOI

  • Various studies have shown that this measurement isn't limited by the geometrical distortion caused due to facial divergence or jaw rotation as compared with the other indices, [29][30][31][32] although these aspects are to be still investigated.

    Angular Relationship between the Palatal Plane and the Anterior Cranial Baseline in Different Sagittal Skeletal Relationships: A Cephalometric Study · 2023 · DOI

  • Considering the complexities of maxillary anatomy, the various permutations of the maxillectomy defect, the current trends in surgical management with presurgical prosthodontic planning, and various prosthodontic treatment options available, it is imperative that a more objective modification of the current classification described in this article is warranted for and could be more operator friendly in finalizing and communicating of the treatment plan.

    Obturators: A proposed classification and its associated techniques · 2023 · DOI

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242 open questions have been extracted from the limitations and future-work passages of 9,373 Orthodontics and Dentofacial Orthopedics papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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