The orthodontic landscape is evolving beyond occlusion and aesthetics, expanding into realms that intersect with systemic health most notably, the airway. This review explores a compelling paradigm shift: the growing body of evidence that links malocclusion with sleep-disordered breathing, particularly obstructive sleep apnea (OSA). No longer viewed in isolation, craniofacial architecture and dental arch relationships are now recognized as potential contributors to compromised airway volume and function. We synthesize current literature to unravel how sagittal and vertical dysmorphologies—such as retrognathic mandibles, narrow maxillary arches, and deep bites correlate with reduced upper airway dimensions and increased risk of airway obstruction during sleep. Furthermore, this review investigates how orthodontic interventions, including maxillary expansion, mandibular advancement, and functional appliance therapy, may influence airway patency. Rather than presenting orthodontics as a cure for OSA, we critically evaluate the extent to which treatment timing, modality, and individual growth patterns determine outcomes. We also spotlight the need for interdisciplinary synergy between orthodontists, sleep physicians, and ENT specialists, advocating for a patient-centred, airway-conscious approach in diagnosis and treatment planning. While the evidence is promising, we emphasize the gaps that persist especially in longitudinal outcomes and standardization of airway assessment protocols. In rethinking malocclusion through the lens of airway health, this review calls for a new orthodontic responsibility: not merely aligning teeth, but potentially aiding in breath, sleep, and systemic wellness. The implications are profound not only for orthodontic strategy but also for the very definition of oral health.

Objective: This systematic review aimed to synthesize longitudinal evidence on the natural changes in orthodontic treatment need among children and adolescents, with a specific focus on identifying malocclusion traits that demonstrate a potential for spontaneous correction over time. Methods: A systematic search was conducted across PubMed/MEDLINE, SienceDirect, Cochrane Library and Google Scholar from inception to November 2025, following PRISMA guidelines. Eligible studies were longitudinal cohorts assessing children and adolescents in mixed or early permanent dentition, with no prior orthodontic treatment at baseline. Outcomes included changes in treatment need measured by indices like the Dental Aesthetic Index (DAI) or Index of Orthodontic Treatment Need (IOTN), and observed self-correction of specific malocclusion traits. Risk of bias was assessed using the Newcastle-Ottawa Scale. Results: Four prospective cohort studies (n=1,253 participants) were included. The evidence revealed a non-linear trajectory of malocclusion prevalence, characterized by an initial decrease from primary to mixed dentition, followed by an increase in early permanent dentition. Despite this, a net decrease in treatment need was observed for many individuals during the transition from mixed to permanent dentition, with one study reporting decreased DAI scores for 60.8% of children. High rates of spontaneous correction were documented for specific traits: anterior open bite (87-99%), Class II malocclusion (83%), and unilateral posterior crossbite (83%). Nevertheless, a persistent, clinically significant treatment need remained, with 22% of 11.5-year-olds classified as having severe or extreme need. Conclusion: Orthodontic treatment need in children is dynamic, not static. While significant self-correction occurs for traits like anterior open bite and posterior crossbite, a substantial proportion of children develop a definitive need for intervention by early permanent dentition. These findings underscore the importance of longitudinal monitoring and cautious timing of orthodontic assessments, particularly during mixed dentition when transient traits may overestimate true long-term need.

Introduction: Clear aligners, introduced in the 1990s with the Invisalign® system, have transformed orthodontics by providing an esthetic and comfortable alternative to fixed appliances. However, questions remain regarding their effectiveness and predictability in achieving different tooth movements and specifically tooth rotation. This systematic review aimed to critically evaluate the efficiency of aligners in controlling rotational movements and to identify the factors influencing their predictability. Materials and Methods: A systematic review was conducted following the PRISMA guidelines. Electronic searches were performed in PubMed, Cochrane Library, and ScienceDirect using a PICOS-based strategy. Methodological quality and risk of bias were assessed using standardized tools (AMSTAR 2, NHLBI/NIH). Results: Studies published between 2014 and 2024 were included. After screening, 14 studies met the eligibility criteria, including prospective and retrospective cohort studies, and systematic reviews. The review revealed that accuracy of tooth rotation is moderate (≈37–60%), it can be improved with attachments and interproximal reduction, but decreases with large or rapidly staged movements. Despite some progress, rotational control remains a key clinical limitation requiring cautious planning and monitoring. Conclusion: Rotations with clear aligners are poorly predictable, particularly for canines and premolars due to limited aligner grip on rounded crowns which often requires the use of auxiliaries and overcorrection strategies. Future high-quality randomized clinical trials and standardized protocols are necessary to strengthen the evidence and improve clinical outcomes.

Introduction: Clear aligners are an aesthetic alternative to fixed appliances, yet their predictability in arch expansion is still debated. This systematic review evaluates the efficiency of aligners in achieving planned expansion and identifies factors influencing outcomes. Materials and Methods: A systematic review was conducted following the PRISMA guidelines. Electronic searches were performed in PubMed, Cochrane Library, and ScienceDirect using a PICOS-based strategy. Methodological quality and risk of bias were assessed using standardized tools (AMSTAR 2, NHLBI/NIH). Results: Nine studies were included in the final analysis, consisting of two systematic reviews and seven cohort studies. The review found that arch expansion predictability is highest in the premolar region (reaching up to 93.53%) but decreases progressively toward the posterior segments, with the lowest accuracy observed at the first molar level (approximately 55-68%). Expansion is primarily achieved through coronal tipping rather than true bodily translation. Conclusion: Aligners effectively manage mild crowding but often result in uncontrolled tipping. To improve predictability, clinicians should utilize overcorrection strategies and pre-program negative torque. Higher-quality randomized clinical trials are necessary to establish standardized protocols.