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OBJECTIVES: 1. To understand how untreated human occlusions evolve at different ages and which are the ethnic variations taking into consideration the different occlusal and craniofacial patterns. 2. To compare the untreated samples with those of treated orthodontic cases which will determine if any diagnostic guidelines or preventive interventions can eliminate or subside the need for retention. METHODOLOGY: The study design provisionally considered is a cross sectional study. The occlusion of the subjects included in the study will be studied through intra and extraoral photographs, models and lateral cephalograms, both from untreated and treated patients. The facial pattern will divide the samples further as vertical and horizontal growth pattern. There will be consideration of gender and age difference among both groups during data collection. The dataset will be divided accordingly, keeping the difference in group size to be minimal so that a normal distribution is seen and reduce the chances of peak evolution criteria in a single group. For the first part of the study, collection and study of an untreated sample will be performed. Inclusion criteria: · Availability of cast models, intra and extraoral pictures and panoramic and lateral cephalograms · Angle classification of Class I malocclusion. · Overjet of 1.5mm and overbite 1.5-2mm. · Class I canine relationship · Class I molar relationship · Occlusion is fulfilling the norms of the six keys of Andrews. Exclusion Criteria : · Presence of caries · Posterior and anterior crossbite · Congenitally missing or supernumerary teeth · Cleft lip and palate or any other syndrome The measurements made on the study models and radiographs will be repeated after 30 days by the same observer by random selection of the sample. Dahlberg formula will determine the method error. In order to find untreated cases with enough ethnic variability, subjects from isolated populations without access to dental care will be reached. Information about their eating habits will also be recorded. This represents the novelty of our study. The second part of the study will be to relate the evolution pattern of the untreated sample with the orthodontically treated cases. Comparison between groups will be made by using the Students t-test. Pearson's correlation coefficient will be used to determine the relationship between the pattern of changes in occlusion with the facial pattern.

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Background: The balance between intra- and extra-oral muscles is believed to influence the growth of the jaws and the position of the teeth. Perioral muscle function can be affected in patients with cleft lip and/or palate due to their inherent anatomical characteristics and the multiple surgical corrections. This research aims to (1) compare the maximum oral muscle pressure of subjects with and without isolated cleft palate (CP) or unilateral cleft lip and palate (UCLP) and (2) to investigate its influence on their dentoalveolar characteristics. Materials and methods: Subjects with CP and UCLP seeking treatment at the Department of Orthodontics of University Hospitals Leuven between January 2021 and August 2022 and subjects without cleft between October 2021 and November 2021 , were invited to participate. The Iowa Oral Performance Instrument (IOPI) was used to measure maximum tongue, lip and cheek pressure. An imbalance score was calculated to express the relation between tongue and lip pressure. Upper and lower intercanine (ICD) and intermolar distance (IMD) were measured on 3D digital dental casts. Data were analyzed with multivariable linear models, correcting for age and gender. Results: 44 subjects with CP or UCLP (mean age: 12.00 years-old) and 104 non-affected patients (mean age: 11.13 years-old) were included. No significant differences in maximum oral muscle pressure or imbalance score were detected between controls and clefts nor between cleft types. Significantly smaller upper ICD and larger upper and lower IMD were found in patients with cleft. A significant difference between the controls and clefts was found in the relation between the oral muscle pressure and the transversal width. The higher the maximum tongue pressure, the wider the upper and lower IMD in cleft patients. The higher the lip pressure in cleft patients, the smaller the upper and lower ICD and IMD. The higher the imbalance score in cleft patients, the larger the upper and lower IMD en lower ICD. There was an imbalance favoring the tongue in cleft patients. Conclusion: Patients with CP or UCLP did not present a reduced maximum oral muscle pressure compared with patients without cleft. Tongue pressure was found to be consistently greater than lip pressure in cleft patients. Moreover, patients with CP and UCLP with larger transversal maxillary width presented systematically higher imbalance scores (favoring the tongue) than those with narrow maxillae. The influence of slow maxillary expansion on maximum oral muscle pressure in cleft patients should therefore not be underestimated.

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This article describes the preliminary development of the ‘Orthodontic Care Index’ (OCI), an evidence-based scoring system that aims to objectify orthodontic treatment need (OTN), - complexity (OTC) and - priority (OTP) by including patient- and treatment-related factors influencing these three components. The development of the OCI involved eight phases. First, all parameters that may play a role in determining the need, complexity or urgency of orthodontic treatment were identified based on a systematic review of the literature. Second, to create a logical outline, the parameters were attributed to different overhead domains and further subdivided into subgroup parameters. Third, in order to quantify the parameters and subgroup parameters, an eight-member panel of orthodontic specialists was consulted to determine the level of impact that each parameter had on the decision-making process to determine OTN, OTC or OTP. Parameters considered of no – or little influence were subsequently eliminated. Fourth, a retrospective ‘convenience sample’ consisting of pre-treatment records of 61 patients, was collected from the database of University Hospitals Leuven. The parameters influencing OTN, OTC and OTP that occurred in this sample were scored by the two main authors by using the generated parameter scoring-list. Fifth, a third expert panel gave an overall score for OTN, OTC and OTP to each patient of the same convenience sample. Sixth, linear regression analysis was performed to estimate the weights of each overhead domain and to construct a formula to calculate a score for OTN, OTC and OTP separately. Seventh, to determine a golden standard, the OTN, OTC and OTP ‘as perceived’ by the orthodontic specialists was obtained by calculating the mean score of the third panel. Lastly, the index performance was quantified by calculating its variability (R-square), sensitivity and specificity. With this preliminary index, the OTN, OTC and OTP can be calculated for a patient as the weighted sum of his/her domain scores. While the variability of OTN, OTC and OTP was relatively low (52.1%, 31.2%, and 52.6% respectively), the sensitivity of the whole index for predicting treatment need, - complexity and - priority was high (98.1%, 82.9% and 92.7% respectively). This suggests that the index is potentially useful for distinguishing a case’s treatment need, complexity and priority. Further refinement and validation of the index is needed to enhance its performance and usefulness.

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Every year, millions of people undergo orthodontic treatment. Although orthodontic treatment is generally considered harmless to the health, it does have adverse effects which require additional professional care and imply a high cost and workload. Alveolar bone loss has long been an important problem in dentistry since it is irreversible and can lead to gingival recession, exposed dental roots, and tooth loss. Orthodontic treatment should not lead to permanent alveolar bone loss if correctly performed. However, certain patients present an increased risk of permanent alveolar bone loss, such as those suffering from periodontal diseases, chronic conditions such as osteoporosis, or genetic predisposition to bone loss, especially in elderly patients. Alveolar bone loss can reduce patients' quality of life by hampering their ability to masticate, speak and socialize. There is a unanimous demand in dentistry to develop a practical approach to treating and preventing alveolar bone loss, which is of great interest to clinicians and patients. Thus, this doctoral project aims to investigate the biological basis of orthodontic tooth movement by focusing on alveolar bone remodeling and preservation.