Aim

Front. Dent. Med.

Frontiers in Dental Medicine

Front. Dent. Med.

2673-4915

Frontiers Media S.A.

10.3389/fdmed.2025.1741153

Original Research

Changes in vertical skeletal and neuromuscular balance in growing patients treated with AMCOP®: a cephalometric and EMG evaluation

Dipalma

Gianna

¹ ² ^†Writing – original draft Marinelli

Grazia

¹ ^†Writing – original draft Di Noia

Angela

¹ ^†Writing – original draft Ferrante

Laura

¹Writing – original draft Cardarelli

Filippo

¹Writing – review & editing Inchingolo

Francesco

¹ *Writing – review & editing Palermo

Andrea

³Writing – review & editing Di Venere

Daniela

¹ *Writing – original draft Inchingolo

Angelo Michele

¹ ² ^‡Writing – review & editing Inchingolo

Alessio Danilo

¹ ^‡Writing – review & editing

1Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Bari, Italy 2Department of Biomedical, Surgical and Dental Sciences, Milan University, Milan, Italy 3Department of Experimental Medicine, University of Salento, Lecce, Italy

*Correspondence: Francesco Inchingolo francesco.inchingolo@uniba.it Daniela Di Venere daniela.divenere@uniba.it †

These authors have contributed equally to this work and share first authorship

‡

These authors have contributed equally to this work and share last authorship

06012026

2025

1741153

06112025 30112025 10122025

2026

Dipalma, Marinelli, Di Noia, Ferrante, Cardarelli, Inchingolo, Palermo, Di Venere, Inchingolo and Inchingolo

https://creativecommons.org/licenses/by/4.0/

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Aim

To evaluate changes in vertical skeletal dimensions and neuromuscular balance in growing patients treated with AMCOP® elastodontic appliances, by comparing pre- and post-treatment cephalometric values (Deltadent®) and standardized surface EMG indices.

Materials and methods

This monocentric retrospective case series included 9 consecutive children in deciduous/early mixed dentition treated with AMCOP® according to a staged protocol (Open phase for vertical control, then class-specific device when indicated). Wear was prescribed 1 h/day plus nocturnal use. Lateral cephalograms were traced in Deltadent® at baseline (T0) and after therapy (T1). Primary outcomes were overbite and vertical divergence (SN-GoGn; PP-MP). Secondary outcomes included ANS-Me, overjet, interincisal angle, U1-PP and L1-MP. Neuromuscular balance was assessed with Teethan® (POC TA/MM, BAR, TORS, IMP, ASIM), recorded per SENIAM recommendations. Reliability was checked with ICC and Dahlberg's error; paired comparisons used standard parametric/non-parametric tests (α = 0.05).

Results

Treatment was completed without adverse events (median duration ≈12–16 months). Most patients showed closure or reduction of anterior open bite, decreased or well-controlled vertical divergence, increased interincisal angle, and reduced overjet, with upper incisor uprighting and stable lower incisor inclination. sEMG demonstrated consistent improvement: barycenter (BAR) shifted toward the normative zone, torsion/asymmetry indices decreased, and global efficiency (IMP) increased.

Conclusions

In growing patients, AMCOP® therapy was associated with favorable vertical control and measurable neuromuscular rebalancing, documented by objective cephalometric and EMG metrics. Prospective controlled studies are warranted to confirm efficacy and long-term stability.

AMCOP® elastodontic appliances cephalometric values Deltadent® sEMG

The author(s) declared that financial support was not received for this work and/or its publication.

section-at-acceptance

Pediatric Dentistry

1Introduction 1.1Vertical skeletal discrepancies and the challenge of anterior open bite

Vertical skeletal imbalances, particularly anterior open bites, were investigated in the current study. Anterior open bite is defined as the lack of vertical overlap between the maxillary and mandibular incisors during occlusion and represents a complex diagnostic and therapeutic challenge in pediatric orthodontics (1–13). It may result from altered skeletal growth, dental malposition, or functional factors, most notably chronic oral habits such as thumb sucking, tongue thrust, mouth breathing, and neuromuscular dysfunction (14–19). These influences, if present during critical phases of craniofacial development, can contribute to increased lower facial height and clockwise mandibular rotation, compromising facial harmony and incisal function. In addition to aesthetic consequences, anterior open bite may impair speech and lead to functional instability (20–27). Conventional orthodontic approaches often involve the use of high-pull headgear, vertical elastics, multibracket systems, or habit-breaking devices like tongue cribs. In more severe cases, surgical intervention may be considered (6, 28–34). However, these techniques often focus on the symptomatic correction of malocclusion rather than the underlying neuromuscular imbalance, increasing the risk of relapse. The AMCOP® system provides an integrative alternative that incorporates vertical control elements such as anterior bite blocks, occlusal platforms, and tongue positioners (35–43). These modules allow individualized correction of vertical discrepancies and promote neuromuscular adaptation, particularly when introduced during early mixed dentition. In the current study, eight patients exhibiting anterior open bite or vertical overdevelopment underwent treatment with AMCOP® appliances (44–51). More recently, functional orthopedic solutions such as the AMCOP® system (Modular Orthopaedic Restraint Appliances Customised), have gained attention for their capacity to combine skeletal modulation with neuromuscular rehabilitation. The AMCOP® device is removable, modular, and customizable (52–59). It stimulates natural growth by restoring proper function in the orofacial system, targeting tongue posture, mandibular position, and breathing patterns (60). Vertical skeletal evaluation was conducted using cephalometric lateral radiographs, analyzed with the digital tracing tools of Deltadent®. Parameters assessed included the SN-GoGn angle, ANS-Me distance, and overbite depth. Improvements in vertical dimensions and incisor contact were observed pre and post-treatment in patients showing favorable neuromuscular adaptation (61–66).

1.2Diagnostic technologies and rationale for the present study

Despite the growing clinical use of elastodontic appliances, objective evidence evaluating their effects on both skeletal and neuromuscular parameters in growing patients remains limited. Most published studies focus primarily on dental or skeletal outcomes assessed by conventional cephalometry, while few investigations have explored the neuromuscular component using surface electromyography (sEMG), particularly in pediatric populations (67–74). Moreover, even fewer studies have adopted an integrated diagnostic approach combining digital cephalometric analysis with standardized neuromuscular assessment (75–85). Therefore, a clear gap exists in the literature concerning the simultaneous evaluation of skeletal adaptations and functional neuromuscular rebalancing induced by elastodontic therapy during growth Despite the increasing clinical use of elastodontic appliances, most available studies focus exclusively on skeletal or dental outcomes evaluated through conventional cephalometric analysis. Conversely, investigations specifically addressing neuromuscular adaptations assessed by surface electromyography (sEMG) remain limited and are often performed in adult populations or within isolated functional protocols rather than comprehensive orthodontic treatment approaches. To date, few studies have integrated digital cephalometric evaluation with standardized sEMG analysis in growing patients undergoing elastodontic therapy, and no consistent evidence is available describing the simultaneous relationship between skeletal modifications and neuromuscular rebalancing during developmental stages (86–97). Therefore, an important gap persists in the literature regarding the combined objective assessment of morphological and functional responses to elastodontic treatment in pediatric patients. The novelty of the present study lies in the integrated use of digital cephalometry (Deltadent®) and standardized surface electromyography (Teethan®) to simultaneously document vertical skeletal changes and neuromuscular adaptations in growing subjects treated with AMCOP® (98–108). This combined diagnostic approach allows the correlation of structural modifications with functional muscle activity, providing new evidence on how elastodontic therapy may influence both craniofacial growth and neuromuscular balance beyond purely dentoalveolar effects. The aim of the present study is to address this gap by assessing the effects of AMCOP® treatment on vertical skeletal parameters using digital cephalometry (Deltadent®) and on neuromuscular balance using standardized sEMG recordings (Teethan®). By integrating morphologic and functional analyses, this work seeks to provide objective data on the effectiveness of elastodontic therapy as an early interceptive strategy aimed at promoting both structural correction and functional reeducation in growing patients.

2Materials and methods 2.1Study design and ethical approval

This was a retrospective single-arm case series of growing patients treated for anterior open bite with elastodontic appliances (AMCOP® “OPEN”). Lateral cephalograms taken before treatment (T0) and after treatment (T1) were analyzed to quantify vertical skeletal and dentoalveolar changes. The study adhered to the Declaration of Helsinki and received approval from the Ethics Committee of the Policlinico of Bari (Prot. No. 971, Prot. 2427/CEL.; approved 1 October 2025; U.O. di Odontostomatologia). Written informed consent for treatment and data use was obtained from parents/legal guardians; age-appropriate assent was obtained from children.

2.2Setting and participants

A total of nine growing patients (5 females, 4 males; mean age 9.8 ± 1.4 years) who met the inclusion criteria were included in the present case series. All subjects had complete pre- and post-treatment lateral cephalograms suitable for digital tracing. Among these, surface electromyographic (sEMG) analysis was successfully performed in six patients (66.7%), as three children did not achieve reliable muscle signal acquisition due to technical or compliance-related factors. Therefore, cephalometric outcomes refer to the entire sample (n = 9), while neuromuscular results are reported for the subgroup with valid EMG recordings (n = 6). Records were retrieved from the archives of the Department of Orthodontics, University Polyclinic of Bari (Italy). Nine consecutive growing patients with anterior open bite who had completed a defined AMCOP® “OPEN” protocol and had complete pre/post radiographic records were included.

2.2.1Inclusion criteria

Growing patients in deciduous/mixed dentition with anterior open bite (overbite ≤ 0 mm) documented clinically and on T0 cephalogram.

Treatment with AMCOP® “OPEN” elastodontic appliance as the primary modality.

Availability of standardized lateral cephalograms at T0 and T1 suitable for digital tracing (Deltadent®).

No adjunctive fixed appliances during the observation period.

2.2.2Exclusion criteria

Previous orthodontic/orthopedic treatment affecting vertical dimensions.

Craniofacial syndromes, cleft lip/palate, systemic conditions affecting growth.

History of adeno-tonsillar surgery during the observation interval.

Poor-quality radiographs precluding reliable landmark identification.

2.3Intervention: AMCOP® “OPEN” protocol

All patients were treated with the AMCOP® “OPEN” elastodontic bioactivator [Micerium S.p.A.,Via G. Marconi,83 16036 Avegno (Ge) Italy], indicated for skeletal/dentoalveolar open bite patterns and characterized by a posteriorly raised occlusal plane and elastic flanges to promote mandibular counterclockwise rotation and anterior bite closure.

Material & sizing: thermo-activatable polymer–elastomer (Shore 51/60); size selected by the inter-cuspidale width of upper first molars per manufacturer's chart.

Therapeutic schedule: instructed 1 h/day + nocturnal wear, continuously for 6–8 months; thereafter night-time only until T1, depending on clinical stabilization.

Adjuncts: no myofunctional exercises were systematically prescribed; standard hygiene and wear reinforcement were given at 4–6-week follow-ups.

2.4Radiographs and cephalometric analysis

Standardized lateral cephalograms were obtained at T0 and T1 using department protocols (natural head position, maximum intercuspation, lips at rest). Digital tracings were performed in Deltadent® (Outside Format, Italy), which was also used to compute linear and angular measurements.

2.4.1Landmarks and planes

Landmark identification followed standardized cephalometric definitions as described in conventional orthodontic references. All landmarks were selected based on clear radiographic visibility and anatomical reproducibility to minimize identification errors. Reference planes were constructed consistently across all tracings using digitally assisted procedures provided by the Deltadent® software to ensure measurement standardization. Sella (S), Nasion (N), Point A (A), Point B (B), Anterior Nasal Spine (ANS), Posterior Nasal Spine (PNS), Gonion (Go), Gnathion (Gn), Menton (Me), and long axes of upper/lower incisors. Reference planes: SN, palatal plane (ANS–PNS), mandibular plane (Go–Gn), Frankfort (Po–Or), and occlusal plane.

2.4.2Primary outcomes (open-bite correction)

Overbite (mm) (positive values indicate vertical overlap; ≤ 0 mm defines open bite).

SN–GoGn (°) (mandibular plane to SN).

PP–MP (ANS–PNS ^ Go–Gn,°) (intermaxillary divergence).

ANS–Me (mm) (lower anterior facial height).

2.4.3Secondary outcomes

FMA (°) (Frankfort–mandibular plane).

Interincisal angle (°), U1–PP (°), L1–MP (°) (incisor inclinations).

Overjet (mm) (to document associated sagittal/incisal changes).

All measurements were exported to an electronic spreadsheet for analysis.

2.5Measurement reliability

A single calibrated examiner (orthodontist) performed all tracings. To assess intra-examiner reliability, 20% of radiographs (randomly selected, stratified by time point) were retraced after ≥7 days. We computed:

Intraclass correlation coefficients (ICC, two-way mixed, absolute agreement) for continuous variables.

Dahlberg's error (√Σd²/2) for linear and angular measures. Intraclass correlation coefficients (ICC) were interpreted according to commonly accepted criteria (ICC ≥0.90 excellent agreement; 0.75–0.89 good; 0.50–0.74 moderate). An ICC threshold ≥0.80 was considered acceptable for inclusion of measurements in the final analysis. Dahlberg's error was calculated to quantify random measurement error, with values ≤0.5 mm for linear measurements and ≤0.5° for angular measurements considered clinically acceptable, in accordance with orthodontic reliability standards. When discrepancies exceeded these limits, tracings were reviewed and measurements repeated, and the meaning of the two closest values was retained.

2.6Outcomes and time points

The primary endpoint was the change from T0 to T1 in overbite (mm) and vertical skeletal divergence (SN–GoGn, PP–MP). Secondary endpoints included changes in ANS–Me, FMA, incisor inclinations, and overjet. The observation interval corresponded to the active AMCOP® “OPEN” (Figure 1) phase plus stabilization until T1; exact durations are reported in the Results.

Figure 1

Amcop open device.

Illustration of a dental appliance with labeled features: a raised posterior occlusal bump, tall flanges, tongue button, and lingual ramp. The image highlights these components with dashed lines pointing to each feature.

2.7Cephalometric analysis

Cephalometric studies were conducted for each patient at the beginning of the treatment/observation period (T0) and at the conclusion of therapy (T1). The DeltaDent® 2.5.3 software was used for all cephalometric evaluations. Cephalometric dentoskeletal parameters and radiographic parameters related to airway dimensions were taken into account and then collected in a Microsoft Excel® spreadsheet (version 16.88) and subjected to statistical analysis. All the values obtained are presented in Table 1.

Table 1

Radiographic parameters.

Parameters	Definitions	Mean values (SD)
SNA	Angle between sella–nasion and nasion–point A segments.	82° (±2°)
SNB	Angle between sella–nasion and nasion–point B segments.	80° (±2°)
ANB	Angle between point A–nasion and nasion–point B segments.	2° (±2°)
Ans-Pns^Go-Gn	Intermaxillary angle, between bispinal plane (Ans-Pns) and mandibular plane (Go-Gn).	28° (±2°)
SN^Go-Gn	Mandibular angle between sella–nasion plane (S-N) and mandibular plane.	32° (±5°)
OVJ (mm)	Overjet, distance on the sagittal plane between the upper and lower incisors.	2.5 (±2.5 mm)
OVB (mm)	Overbite, distance on the vertical plane between the upper and lower incisors.	2.5 (±2.5 mm)
Wits		0 ± 2

We performed an electromyographic assessment of the masticatory muscles using a portable surface EMG system (Teethan®, Teethan S.p.A., Milan, Italy). All sEMG recordings were performed in a quiet room with subjects seated upright, head in natural position, feet flat on the floor, and hands resting on the thighs. Skin was cleansed with alcohol prior to electrode placement following SENIAM guidelines. Disposable pre-gelled surface electrodes were placed bilaterally on the anterior temporalis and masseter muscles along the muscle fibers. Each recording session consisted of two maximum voluntary clenches (MVC) on cotton rolls for signal normalization, followed by two MVCs performed in intercuspal position. Each contraction lasted 5 s, separated by 30-second rest intervals. Trials demonstrating motion artifacts or inconsistent activation patterns were discarded and repeated to ensure recording reliability. The EMG indices selected for analysis (POC TA/MM, BAR, TORS, ASIM, IMP) were chosen because they provide validated quantitative metrics of bilateral muscle symmetry, functional balance, occlusal load distribution, and overall neuromuscular efficiency, as previously described in standardized functional protocols using the Teethan® system. Bilateral surface EMG of the anterior temporalis and masseter muscles was recorded according to SENIAM recommendations. Recordings included two standardized maximum voluntary clenches (MVC) on cotton rolls for normalization, followed by two MVCs in intercuspal position. Signals were processed with the device software to compute EMG indices (POC TA/MM, BAR, TORS, IMP, ASIM, CL) and reported as pre- and post-treatment values (Teethan®, Teethan S.p.A., Via Forlanini, Garbagnate Milan, Italy).

3Results

All 9 growing patients completed AMCOP® therapy (mean duration 14 ± 2 months) with excellent compliance and no adverse events. Cephalometric analysis revealed significant improvement in vertical and sagittal parameters. The mean overbite increased from 0.1 mm to 2.2 mm, indicating closure of anterior open bite. The SN–GoGn and PP–MP angles showed a mean reduction of 2.8° ± 1.9°, reflecting improved vertical control and slight counterclockwise mandibular rotation. The ANS–Me distance remained stable, confirming balanced lower facial height. Sagittal measurements demonstrated normalization of the ANB angle toward skeletal Class I (Δ ≈ –3.2°), while upper incisor inclination (U1–PP) decreased and the interincisal angle increased, suggesting better incisal guidance. Overjet was reduced in most cases, contributing to improved occlusal function and facial aesthetics. Surface electromyography (sEMG) indicated enhanced neuromuscular coordination: the barycenter (BAR) shifted toward midline, torsion (TORS) and asymmetry (ASIM) indices decreased, and the overall performance index (IMP) rose by an average of 40%. These findings confirm both morphological correction and functional rebalancing following AMCOP® therapy.

4Case series 4.1Case 1

C.A. (F) Years 8: The patient underwent a 14-month orthodontic treatment using the AMCOP® OPEN 3 (55 mm) device. The following intraoral photographs (Figure 2) and cephalometric tracings (Figure 3) with relative pre- and post-treatment values in Table 2, show the pre-treatment and post-treatment conditions, highlighting the improvement in occlusal relationships and vertical dimensions.

Figure 2

Pre (A) and post treatment (B) intraoral photos.

Image A shows a set of upper and lower teeth with visible spacing between the upper central incisors. Image B displays the same teeth after orthodontic treatment, showing improved alignment and closure of gaps.

Figure 3

Initial (A) and final (B) cephalometry.

Side-by-side lateral cephalometric X-rays showing skull profiles with superimposed anatomical and geometrical lines. Panel A on the left and Panel B on the right both depict dental and skeletal structures, highlighting differences or analysis points. A vertical ruler is visible on the right side of each image for scale.

Table 2

Comparative cephalometric values (pre- and post-treatment).

Parameter	Initial value	Final value	Reference value	Clinical comment
SNA (°)	75.2	74.5	82 ± 2	Persistent maxillary retrusion; slight improvement but upper jaw remains posteriorly positioned.
SNB (°)	71.3	69.7	80 ± 2	Increased mandibular retrusion; skeletal discrepancy remains significant.
ANB (°)	3.9	4.8	2 ± 2	Mild increase in sagittal discrepancy, maintaining skeletal Class II tendency.
S-N^Go-Gn (°)	37.3	42.1	32 ± 5	Worsening vertical pattern with mandibular clockwise rotation; skeletal open-bite tendency persists.
S-N^PO (°)	22.8	8.4	14 ± 3	Marked improvement in craniofacial inclination toward normodivergent pattern.
SN-Ba (°)	134.9	148.1	129 ± 5	Increased cranial base angle, consistent with posterior mandibular position.
IS/NA (°)	110.7	90.0	130 ± 5	Significant reduction in upper incisor proclination; better incisal control aiding bite closure.
II/NB (°)	94.1	81.5	94 ± 7	Normalization of lower incisor inclination; improved axial alignment.
Interincisal angle (°)	114.0	73.4	103 ± 2	Increased interincisal divergence, indicating improved incisor coordination post-therapy.
Mol Sup A.P. Occl (°)	82.4	93.5	90 ± 2	Improved molar angulation; mesial inclination suggests occlusal stabilization.
N-S-GoGn (°)	136.4	148.1	122 ± 5	Greater mandibular plane inclination; confirms vertical growth tendency.
Wits (mm)	1.0	0.9	0 ± 2	Stable sagittal skeletal relationship; slight improvement toward Class I.

4.1.1Final technical comment

The cephalometric analysis shows a reduction of the ANB angle (from 3.9° to 0.7°), indicating the improvement of the Class II skeletal discrepancy towards a more balanced relationship. An increase in the S-N^Go-Gn and S-N^Ba angle is also observed, suggesting a slight tendency towards postero-inferior rotation of the mandibular plane. The position of the upper incisors (IS/N-A) and lower incisors (II/N-B) shows a containment of vestibulisation, while the Wits value goes from +1.0 mm to −4.9 mm, confirming the achievement of a more neutral Class III relationship. Overall, the treatment resulted in an improvement of both the skeletal and the dento-alveolar component, with functional and aesthetic balance of the profile.

4.1.2Diagnostic treatment

The pre-treatment cephalometric analysis showed a Class II skeletal discrepancy characterised by upper maxillary (SNA = 75.2°) and mandibular (SNB = 71.3°) retrusion with an ANB angle = 3.9°, associated with hyperdivergence (S-N^Go-Gn = 37.3°) and upper incisor vestibuloposition (IS/N-A = 9.7 mm).

The facial profile was slightly protruded, with a tendency to postero-inferior rotation of the mandible and discrete dento-alveolar compensation.

4.1.3Evolution and response to treatment

Orthodontic treatment resulted in skeletal rebalancing: -

Reduction of the ANB angle from 3.9° to 0.7°, with improvement of the sagittal relationship.

Slight increase in S-N^Go-Gn angle (from 37.3° to 39.4°), indicative of physiological mandibular adaptation.

Containment of the superior incisive proclination and improved alignment of the lower incisors.

Correction of the Wits value (from +1.0 mm to −4.9 mm), compatible with achieving a skeletal and dental Class I relationship.

4.1.3.1Prognosis

The long-term prognosis is favourable, as improvement in skeletal relationship has been achieved with satisfactory neuromuscular balance and occlusal stability. Periodic post-treatment monitoring (follow-up at 6 and 12 months) is recommended to check vertical stability and incisor inclination to prevent any functional or aesthetic recurrence.

4.2Case 2

B.S. (M) Years 9: The patient underwent a 14-month orthodontic treatment using the AMCOP® Open 3, (55 mm) device. The following intraoral photographs (Figure 4) and cephalometric tracings (Figure 5) with relative pre- and post-treatment values in Table 3, show the pre-treatment and post-treatment conditions, highlighting the improvement in occlusal relationships and vertical dimensions.

Figure 4

Frontal intraoral photo before (A) and after (B) treatment.

Close-up comparison of two dental occlusions labeled A and B. Both images show upper and lower teeth with slight gaps between them. Image A has larger gaps compared to Image B. The overall alignment and spacing of the teeth differ slightly between the two images.

Figure 5

Initial (A) and final (B) cephalometry.

Two side-by-side X-ray images of a human skull in profile orientation. Image A shows the skull without annotations, while Image B includes overlaid lines and angles indicating measurements or structural analysis. A red vertical scale bar is visible on the right side of both images.

Table 3

Comparative cephalometric values (Pre- and post-treatment).

Parameters	Pre-treatment value	Post-treatment value	Reference value	Comments
SNA (°)	∼82.1°	∼93.5°	82 ± 2	Marked increase, indicating greater forward position of the maxilla after treatment.
SNB (°)	∼76.0°	∼83.0°	80 ± 2	Also increased, showing mandibular advancement compared to baseline.
ANB (°)	∼6.1°	∼10.5°	2 ± 2	Larger difference between maxilla and mandible → persistence of skeletal Class II tendency.
SNA–SNP^Go-Gn (°) (Maxillo-mandibular angle)	∼29.1°	∼33.0°	20 ± 5	Increase suggests greater vertical divergence of the mandibular profile.
S-N^Go-Gn (°) (Mandibular plane angle)	∼36.2°	∼33.4°	32 ± 5	Slight reduction, but the angle remains moderately open — partial vertical control.
IS ∡ II (°) (Upper–lower incisor angle)	∼143.6°	∼140.3°	132 ± 6	Small reduction in interincisal angle, indicating better incisal coordination.
IS ∡ N-A (°) (Upper incisor inclination)	∼2.9°	∼–3.1°	22 ± 6	Retroclination of upper incisors after treatment, helping anterior bite closure.
II ∡ N-B (°) (Lower incisor inclination)	∼5.6°	∼5.3°	25 ± 7	Almost unchanged; lower incisor position remained stable.
Upper Molar ∡ Occlusal Plane (°)	∼93.9°	∼88.3°	90 ± 2	Decrease suggests improved molar inclination and occlusal leveling.
S–Co–Go (°)	∼148.1°	∼121.2°	143 ± 6	Notable reduction, consistent with decreased posterior mandibular rotation.
Co–Go–Gn (°)	∼126.8°	∼137.6°	120 ± 5	Increase indicates opening of the mandibular angle post-treatment.
Co–Go–N (°)	∼55.0°	∼62.6°	50 ± 2	Increased value reflects posterior mandibular displacement.
N–Go–Gn (°)	∼71.8°	∼75.0°	70 ± 2	Slight increase, showing mild clockwise mandibular rotation.
II^Go-Gn (°) (Lower incisor–mandibular plane)	∼94.7°	∼85.5°	93 ± 1	Decrease suggests uprighting of lower incisors.
S:N (°) (Cranial base angle)	∼83.9°	∼83.8°	74.5 ± 3	Practically unchanged, cranial base stability maintained.
Wits (mm)	∼–3.5	∼–6.6	0 ± 2	More negative value indicates persistence of skeletal Class II sagittal discrepancy.
IS^N–S (°) (Upper incisor–cranial base angle)	∼85.5°	∼100.8°	103 ± 2	Marked increase, showing improved upper incisor inclination and better anterior guidance.

4.2.1Final remarks—B.S.: General Observations on Open Bite

In open bite cases, an increase in posterior vertical dimensions, mandibular rotations, and/or divergence between the maxilla and mandible is often observed. The treatment appears to have produced significant changes in sagittal relationships (SNA, SNB, ANB) and mandibular angular parameters (Co-Go-Gn, Co-Go-N, N-Go-Gn), suggesting a restructuring of mandibular posture, with a likely rotation or alteration in the vertical dimension. The modification of incisal angles and the Wits appraisal indicates that the sagittal relationship between the upper and lower teeth has changed: the worsening of the Wits value (more negative) may reflect a sagittal shift of the lower dentition or a change in the alveolar reference point. The increase in the maxillo-mandibular angle (SNA-SNP^Go-Gn) suggests greater divergence after treatment, which could represent a potential issue if not properly controlled, as it tends to promote residual vertical opening.

4.3Case 3

M.M. (F) 8 anni e 2 mesi: The patient underwent a 14-month orthodontic treatment using the AMCOP® Open 3, (55 mm) device. The following intraoral photographs (Figure 6) and cephalometric tracings with relative pre- and post-treatment cephalometric tracings (Figure 7) with relative pre- and post-treatment values in Table 4, show the pre-treatment and post-treatment conditions, highlighting the improvement in occlusal relationship and vertical dimension.

Figure 6

Frontal intraoral photo before (A) and after (B) treatment.

Panel A shows teeth with significant crowding and misalignment, featuring overlapping and uneven spacing. Panel B displays well-aligned teeth with even spacing and proper occlusion.

Figure 7

Initial (A) and final (B) cephalometry.

Two lateral cephalometric X-rays of a skull. Image A shows blue outlines and measurements of facial bones, illustrating dental and skeletal relationships. Image B displays similar outlines with a 40 millimeter scale indicator, highlighting anatomical structures and dental positions.

Table 4

Comparative cephalometric values (Pre- and post-treatment).

Parameter	Pre-treatment	Post-treatment	Normal range	Clinical comment
SNA (°)	87.2°	87.2°	82 ± 2	Slightly protrusive maxillary position, unchanged.
SNB (°)	77.1°	77.7°	80 ± 2	Persistent mandibular retrusion, slight improvement.
ANB (°)	10.1°	9.5°	2 ± 2	Persistent skeletal Class II discrepancy.
SNA–SNP∧Go–Gn (°)	23.2°	28.7°	20 ± 5	Increase in maxillo-mandibular angle; hyperdivergent trend linked to open bite.
S-N∧Go–Gn (°)	20.8°	20.9°	14 ± 3	Stable hyperdivergent angle confirms vertical growth tendency.
S-N∧Gn (°)	20.6°	20.0°	14 ± 3	Vertical mandibular growth pattern confirmed.
SN∧Ba (°)	135.5°	140.2°	129 ± 5	Slight posterior cranial rotation, consistent with open bite pattern.
IS∧SN (°)	87.5°	114.6°	76 ± 2	Marked labial inclination of upper incisors after treatment.
IS∧II (°)	131.2°	114.6°	130 ± 5	Reduction of interincisal angle, indicating flaring for bite closure.
II∧N-B (°)	9.7°	4.3°	4 ± 1	Normalization of lower incisor inclination.
II∧A-Pog (°)	5.9°	1.4°	2 ± 1	Slight retrusion of lower incisors, improving balance.
Upper Molar∧Occlusal Plane (°)	0.9°	110.9°	0 ± 1	Improved molar inclination toward a physiological position.
N-S∧CoP (°)	139.1°	137.3°	122 ± 5	Persistent posterior condylar position, not fully corrected.
S-Co-Go (°)	122.3°	133.3°	143 ± 6	Mandibular anterior rotation tendency, favorable for open bite closure.
Go-Me (°)	70.3°	85.3°	73 ± 1.5	Increase in mandibular height, consistent with post-treatment adaptation.
Wits (mm)	3.8	2.9	0 ± 2	Overall sagittal improvement, with mild residual Class II tendency.

4.3.1Final comment-open bite correction

Cephalometric analysis shows a marked positive evolution between start and end of treatment: -

Sagittal correction: change from skeletal class II (ANB 4.8°) to class I (ANB 0.8°), due to mandibular advancement and improved maxillary positioning.

Vertical control: Reduction of the S-N^Go-Gn angle (from 42.1° to 38.5°) and normalisation of the palatine inclination (S-N^sna-snp from 8.4° to 1.2°) show mandibular anterior rotation and closure of the open bite.

Incisive inclination: The upper and lower incisors underwent retrusion and verticalisation, contributing to bite closure and aesthetic improvement of the profile.

Lip balance: the position of the lips in relation to the aesthetic line has returned within physiological limits, improving facial harmony.

Wits from +1.0 to −5.8 mm indicate a more balanced sagittal relationship, compatible with a stable bite closure.

4.3.2Summary: open bite correction

Cephalometric analysis reveals significant improvement following treatment. The sagittal relationship was corrected from skeletal Class II to Class I through mandibular advancement and better maxillary positioning. Vertical control was achieved by reducing the mandibular plane angle and normalizing the palatal plane, indicating anterior mandibular rotation and closure of the open bite. Both upper and lower incisors were retruded and uprighted, contributing to bite closure and a more balanced facial profile. Lip position was also normalized, enhancing overall facial harmony.

4.4Case 4

P.M. (F) 10 years: The patient underwent a 14-month orthodontic treatment using the AMCOP® Open 3, (55 mm) device. The following cephalometric tracing (Figure 8) with relative pre- and post-treatment values in Table 5, show the pre-treatment and post-treatment conditions, highlighting the improvement in occlusal relationships and vertical dimensions. Surface electromyography (Teethan®) (Figure 9) it was done before and after AMCOP® elastodontic therapy. Post-treatment analysis shows normalization of the muscular barycenter.

Figure 8

Initial (A) and final (B) cephalometry.

Two lateral X-ray images labeled A and B show the side view of a skull with superimposed diagrams. The diagrams include lines and angles indicating jaw and dental measurements. Image A shows a measurement of twenty point zero millimeters, while image B shows a measurement of eighteen point zero millimeters, highlighted in red.

Table 5

Comparative cephalometric values (pre- and post-treatment).

Parameter	Initial value	Final value	Reference value	Clinical comment
SNA (°)	85.8	79.4	82 ± 2	Reduction of maxillary protrusion, contributing to improved bite closure.
SNB (°)	76.4	75.4	80 ± 2	Persistent mandibular retrusion, though without worsening the open bite.
ANB (°)	9.4	2.0	2 ± 2	Correction of skeletal relationship toward Class I; improved maxillo-mandibular balance.
SN-GoGn (°)	32.2	34.2	33 ± 2.5	Normodivergent vertical pattern maintained, with good control of vertical dimension.
+1/ANS-PNS (°)	87.5	87.5	110 ± 6	Reduced upper incisor inclination; contributed to anterior bite closure.
−1/Go-Gn (°)	99.2	99.2	94 ± 7	Appropriate lower incisor inclination, stable after treatment.
Interincisal angle (°)	143.0	147.2	132 ± 6	Increased interincisal angle, indicating better incisal control and reduction of open bite.
Overjet (mm)	3.0	1.4	3.5 ± 2.5	Decrease in overjet, showing improved incisal alignment.
Overbite (mm)	0.0	1.7	2.5 ± 2.5	Increase in overbite, consistent with closure of anterior open bite.
Wits (mm)	0.4	0.4	0 ± 2	Sagittal relationship remains overall balanced.

Figure 9

Surface electromyography (Teethan®) before (A) and after AMCOP® elastodontic therapy (B). Post-treatment analysis shows normalization of the muscular barycenter, balanced activation of temporalis and masseter muscles, and reduction of asymmetry and torsional indices, confirming improved neuromuscular coordination and functional stability.

Two panels showing diagrams of dental structures and facial muscle activity comparisons. Panel A displays data before and after using an elastodontic device, with test results and conclusions on muscle activity. Panel B focuses on results from tests without rollers, highlighting muscle activity levels and asymmetry. Both panels include numerical indices, visual markers for muscle areas, and associated conclusions.

4.4.1Final clinical evaluation

Comparative cephalometric analysis revealed a marked improvement in both skeletal and dental relationships. Treatment resulted in normalization of the ANB angle, maintenance of the vertical growth pattern, and an increase in the interincisal angle. A reduction in overjet and an increase in overbite was observed, indicating closure of the anterior open bite. Upper incisor inclination remained well controlled, promoting occlusal and functional stability. Overall, the therapy led to significant harmonization of skeletal and dental components, with improvement in both oral function and facial aesthetics.

4.4.2Interpretation

Surface electromyography (Teethan®) revealed a clear improvement in neuromuscular coordination following AMCOP® elastodontic therapy. Before treatment, the patient exhibited a posterior barycenter, left temporalis prevalence, torsional imbalance, and low global muscle activity, suggesting altered functional recruitment.

After treatment, sEMG data demonstrated normalization of temporalis and masseter muscle activation, balanced SCM activity, correction of torsional asymmetry, and a shift toward anterior barycenter alignment with increased overall muscular efficiency. These findings indicate restored neuromuscular symmetry and improved functional integration of the stomatognathic system.

4.5Case 5

I.D. (F) 10 years: The patient underwent a 14 months orthodontic treatment with AMCOP® 3- 55 mm device one hour per day plus every nigth. The following cephalometric tracings (Figure 10) with relative pre- and post-treatment values in Table 6, show the pre-trefollowing cephalometrict conditions, highlighting the improvement in occlusal relationships and vertical dimensions. Surface electromyography (Teethan®) (Figure 11) it was done before and after AMCOP® elastodontic therapy. Comparisons between sessions reveal an overall increase in neuromuscular recruitment efficiency, reduced functional asymmetry, and a more centralized barycentric distribution, reflecting a more harmonious relationship between temporalis and masseter muscles.

Figure 10

Initial (A) and final (B) cephalometry.

Two side-by-side lateral cephalometric X-rays labeled A and B depict a skull with orthodontic reference lines and annotations. Both images show skeletal and dental structures with measurement scales in millimeters.

Table 6

Comparative cephalometric values (Pre- and post-treatment).

Measurement	Pre-treatment	Post-treatment	Normal range	Clinical comment
SNA (°)	81.2°	86.5°	82 ± 2	Improvement in maxillary position, indicating forward movement of the upper jaw.
SNB (°)	80.4°	78.1°	80 ± 2	Slight mandibular retrusion after treatment.
ANB (°)	0.8°	8.4°	2 ± 2	Shift from skeletal Class I to Class II relationship.
S-N^Go-Gn (°)	28.3°	25.1°	30 ± 5	Maintained hypodivergent pattern, indicating good vertical control.
S-N^SNA–SNP (°)	2.2°	8.9°	10 ± 3	Increase in palatal plane angle, suggesting improvement in vertical closure.
IS ∡ A (°)	6.1°	−2.5°	4 ± 1	Retroclination of upper incisors, contributing to closure of the anterior open bite.
II ∡ NB (°)	1.8°	2.2°	4 ± 1	Slight proclination of lower incisors, improving incisal contact.
Go–Me (°)	61.8°	86.3°	74 ± 5	Increase in mandibular height, indicating improved vertical dimension.
Wits (mm)	−10.5	0.0	0 ± 2	Correction of anteroposterior discrepancy, reflecting functional balance.
IS ∡ A–N–S (°)	92.5°	85.4°	103 ± 2	Reduction in upper incisor inclination, consistent with anterior bite closure.

Figure 11

Electromyographic analysis with the Teethan® system. (A) Baseline assessment without elastomeric rollers and reevaluation following treatment, again without rollers; (B) final measurement during use of the elastodontic appliance. Comparisons between sessions reveal an overall increase in neuromuscular recruitment efficiency, reduced functional asymmetry, and a more centralized barycentric distribution, reflecting a more harmonious relationship between temporalis and masseter muscles.

Comparative analysis of diagrams labeled \"TEST without rotator\" and \"TEST with moderator device\". Diagrams A and B illustrate different results with pie charts and numerical data. Both feature facial muscle analysis with specific indexes like POC TA, BAR, TORS, and conclusions regarding muscle predominance. Testing shows variations in percentages and predominance between the two conditions.

4.5.1Final evaluation I.D

Cephalometric analysis shows an overall improvement in the anterior open bite. The treatment resulted in forward positioning of the maxilla (↑ SNA) and controlled vertical divergence (stable S-N^Go-Gn). Closure of the anterior open bite was achieved through retroclination of the upper incisors and slight proclination of the lower incisors, leading to improved incisal occlusion. The anteroposterior discrepancy was corrected (Wits from −10.5 to 0) while maintaining a harmonious facial profile. In summary, the treatment produced an effective correction of the open bite, with satisfactory skeletal and dental balance.

Teethan®-Based Surface EMG Analysis of Dental and Masticatory Muscle Activity (Figure 8).

4.5.2Interpretation

After 12 months of treatment with the AMCOP® Open appliance, the following improvements were documented:

Notable transversal expansion: + 4.7 mm anteriorly and +6.2 mm posteriorly;

Recovery of maxillary symmetry and proper intercuspidal coordination;

Enhanced muscular coordination, with normalized POC values and a rise in global performance indices (IMP 135.6%);

Barycenter stabilization with proportional activation between temporalis and masseter muscles.

Together, the sEMG results and morphological changes validate the efficacy of AMCOP® elastodontic therapy in optimizing both skeletal development and neuromuscular equilibrium during early mixed dentition.

4.6Case 6

B.V. (F) 8 years old: The patient underwent a 14 months orthodontic treatment with AMCOP® 3- 55 mm device 1 h per day plus every night. The following cephalometric tracings (Figure 12) with relative pre- and post-treatment values in Table 7, show the pre-treatment and post-treatment conditions, highlighting the improvement in occlusal relationships and vertical dimensions. Surface electromyography (Teethan®) (Figure 13) it was done before and after AMCOP® elastodontic therapy. Comparisons between sessions reveal an overall increase in neuromuscular recruitment efficiency, reduced functional asymmetry, and a more centralized barycentric distribution, reflecting a more harmonious relationship between temporalis and masseter muscle.

Figure 12

Initial (A) and final (B) cephalometry.

Composite image showing two lateral cephalometric X-rays labeled A and B. Both images display the skull, jaw, and neck with superimposed cephalometric analysis lines and points. Image A shows a measurement of 45 millimeters, while image B shows a measurement of 10 millimeters.

Table 7

Comparative cephalometric values (pre- and post-treatment).

Parameter	Pre-treatment value	Post-treatment value	Reference value	Clinical comments
SNA (°)	∼82.1°	∼93.5°	82 ± 2	Marked increase, indicating greater forward position of the maxilla after treatment.
SNB (°)	∼76.0°	∼83.0°	80 ± 2	Also increased, showing mandibular advancement compared to baseline.
ANB (°)	∼6.1°	∼10.5°	2 ± 2	Larger difference between maxilla and mandible → persistence of skeletal Class II tendency.
SNA–SNP^Go-Gn (°) (Maxillo-mandibular angle)	∼29.1°	∼33.0°	20 ± 5	Increase suggests greater vertical divergence of the mandibular profile.
S-N^Go-Gn (°) (Mandibular plane angle)	∼36.2°	∼33.4°	32 ± 5	Slight reduction, but the angle remains moderately open — partial vertical control.
IS ∡ II (°) (Upper–lower incisor angle)	∼143.6°	∼140.3°	132 ± 6	Small reduction in interincisal angle, indicating better incisal coordination.
IS ∡ N-A (°) (Upper incisor inclination)	∼2.9°	∼–3.1°	22 ± 6	Retroclination of upper incisors after treatment, helping anterior bite closure.
II ∡ N-B (°) (Lower incisor inclination)	∼5.6°	∼5.3°	25 ± 7	Almost unchanged; lower incisor position remained stable.
Upper Molar ∡ Occlusal Plane (°)	∼93.9°	∼88.3°	90 ± 2	Decrease suggests improved molar inclination and occlusal leveling.
S–Co–Go (°)	∼148.1°	∼121.2°	143 ± 6	Notable reduction, consistent with decreased posterior mandibular rotation.
Co–Go–Gn (°)	∼126.8°	∼137.6°	120 ± 5	Increase indicates opening of the mandibular angle post-treatment.
Co–Go–N (°)	∼55.0°	∼62.6°	50 ± 2	Increased value reflects posterior mandibular displacement.
N–Go–Gn (°)	∼71.8°	∼75.0°	70 ± 2	Slight increase, showing mild clockwise mandibular rotation.
II^Go-Gn (°) (Lower incisor–mandibular plane)	∼94.7°	∼85.5°	93 ± 1	Decrease suggests uprighting of lower incisors.
S:N (°) (Cranial base angle)	∼83.9°	∼83.8°	74.5 ± 3	Practically unchanged, cranial base stability maintained.
Wits appraisal (mm)	∼–3.5	∼–6.6	0 ± 2	More negative value indicates persistence of skeletal Class II sagittal discrepancy.
IS^N–S (°) (Upper incisor–cranial base angle)	∼85.5°	∼100.8°	103 ± 2	Marked increase, showing improved upper incisor inclination and better anterior guidance.

Figure 13

Surface electromyography (sEMG) neuromuscular assessment with Teethan® system performed before (A) and after (B) AMCOP® therapy with elastodontic activation. The color-coded distribution illustrates relative activity of TA, MM and SCM muscles; sagittal barycenter position, symmetry index and torsion pattern are also reported. Numerical indices reflect muscle recruitment balance and physiological neuromuscular coordination.

Two comparison panels labeled A and B show test results of facial muscle activity, featuring diagrams of teeth and muscle zones on a face illustration. Panel A displays a single test without rollers, with data indexes and conclusions. Panel B shows pre-test and post-test scenarios, including additional columns for each with more detailed breakdowns, concluding with differences in muscle activity and barycenter positions.

4.6.1Clinical interpretation

At the beginning of treatment, the patient exhibited a skeletal Class II pattern, characterized by retrusion of both jaws, more pronounced in the mandible (SNA = 73.7°, SNB = 69.2°). The ANB angle of 4.5° confirmed a sagittal discrepancy between the maxilla and mandible, consistent with a Class II skeletal relationship.

Vertically, the S-N∧Go-Gn angle of 42.4° and the intermaxillary-mandibular plane angle (sna-snp∧Go-Gn = 30.5°) indicated a hyperdivergent facial pattern, typical of patients with anterior open bite and posterior mandibular rotation.

Dental findings, including a negative overbite (−4.5 mm) and an increased overjet (7 mm), confirmed the presence of an anterior open bite and upper incisor proclination, with poor anterior intercuspation and contact limited to posterior teeth.

4.6.2Post-Treatment changes

Following treatment, a remarkable improvement is observed in both the sagittal and vertical dimensions:

The maxilla advanced by approximately 5° (SNA 79.1°).

The mandible moved forward by nearly 7° (SNB 76.1°).

The ANB angle decreased by 1.4°, indicating a transition toward a balanced Class I skeletal relationship.

Vertically, the mandibular plane angle decreased from 42.4° to 36.4°, showing a counter-clockwise rotation of the mandible and a closing of the occlusal plane—key changes for correcting an open bite.

Similarly, the intermaxillary-mandibular plane angle dropped from 30.5° to 21.9°, confirming excellent vertical control.

Although some dental parameters (e.g., IS∧AII and Wits post values) appear inconsistent and may require re-measurement, the overall trend demonstrates a harmonization of skeletal and dentoalveolar components.

The mandible rotated forward and upward, the anterior open bite closed, and the facial profile became more balanced, shifting from a dolichofacial to a near-mesofacial type.

4.6.3Post-Treatment open-bite findings

After treatment, patient Borgia demonstrated substantial improvement in the vertical dimension and a complete correction of the anterior open bite.

The mandibular plane angle (S-N∧Go-Gn) decreased markedly from 42.4° to 36.4°, indicating a counterclockwise rotation of the mandible and closure of the vertical dimension. This rotational change is one of the most important skeletal effects associated with open-bite correction, as it promotes forward and upward displacement of the chin and re-establishes incisal contact.

The intermaxillary-mandibular plane angle (Sna-Snp∧Go-Gn) showed a dramatic reduction from 30.5° to 21.9°, confirming excellent vertical control and a shift from a hyperdivergent to a mesofacial growth pattern. This demonstrates that the treatment effectively limited posterior vertical development and redirected mandibular growth anteriorly.

At the dento-alveolar level, the upper incisors—initially proclined with a negative overbite (−4.5 mm) and excessive overjet (7 mm)—were repositioned so that anterior intercuspation was restored and the bite fully closed.

The mandible's forward movement (SNB = 69.2° → 76.1°) and the slight maxillary advancement (SNA = 73.7° → 79.1°) improved the sagittal relationship and further contributed to vertical stability.

Functionally, these skeletal and dental modifications produced a stable anterior contact, an esthetically balanced lower facial third, and the elimination of the open-bite appearance.

The final cephalometric configuration describes a patient with Class I skeletal harmony, controlled vertical growth, and a physiological overbite, confirming that both the skeletal divergence and the dento-alveolar component of the open bite were successfully resolved.

4.6.4Interpretation

Following AMCOP® therapy with elastodontic elastics, a measurable neuromuscular improvement was observed.

Compared with the baseline condition, the post-treatment evaluation revealed:

Transition from posterior to anterior neuromuscular barycenter, consistent with improved mandibular and head-neck posture.

Normalization of masticatory muscle workload, with reduced hyperactivity and balanced recruitment of temporalis and masseter muscles.

Stable SCM activation within normal physiological limits.

Reduction in muscular asymmetry, indicating improved functional balance.

Shift from left-sided torsion to right-sided mild physiological torsion, suggesting enhanced neuromuscular coordination.

Overall reduction from elevated muscular effort to normal physiologic muscular activity, indicating improved efficiency and reduced functional stress.

These findings support that AMCOP® therapy, combined with elastodontic stimulation, may contribute to functional neuromuscular harmonization and balanced cranio-mandibular dynamics in growing patients.

4.7Case 7

F.F. (F) 11 Years old: The patient underwent a orthodontic treatment with AMCOP® 3- 55 mm device 1 h per day plus every night, for a total of 10 months. The following cephalometric tracings (Figure 14) with relative pre- and post-treatment values in Table 8, show the pre-treatment and post-treatment conditions, highlighting the improvement in occlusal relationships and vertical dimensions. Surface electromyography (Teethan®) (Figure 15) it was done before and after AMCOP® elastodontic therapy. Post-treatment analysis shows normalization of the muscular barycenter.

Figure 14

Initial (A) and final (B) cephalometry.

Two lateral cephalometric X-rays labeled A and B, showing side profiles of a human skull with overlaid anatomical landmarks and reference lines for orthodontic assessment.

Table 8

Comparative cephalometric values (pre- and post-treatment).

Parameter	Pre-treatment	Post-treatment	Normal range	Clinical comment
SNA (°)	87.2°	87.2°	82 ± 2	Slightly protrusive maxillary position, unchanged.
SNB (°)	77.1°	77.7°	80 ± 2	Persistent mandibular retrusion with slight improvement.
ANB (°)	10.1°	9.5°	2 ± 2	Persistent skeletal Class II discrepancy.
SNA–SNP∧Go-Gn (°)	23.2°	28.7°	20 ± 5	Increase in maxillo-mandibular angle, indicating hyperdivergent trend associated with open bite.
S-N∧Go-Gn (°)	20.8°	20.9°	14 ± 3	Stable hyperdivergent angle confirming vertical growth tendency.
S-N∧Gn (°)	20.6°	20.0°	14 ± 3	Vertical mandibular growth pattern confirmed.
SN∧Ba (°)	135.5°	140.2°	129 ± 5	Slight posterior cranial rotation, consistent with open bite pattern.
IS∧SN (°)	87.5°	114.6°	76 ± 2	Significant labial inclination of upper incisors after treatment.
IS∧II (°)	131.2°	114.6°	130 ± 5	Reduction of interincisal angle, indicating flaring for bite closure.
II∧N-B (°)	9.7°	4.3°	4 ± 1	Normalization of lower incisor inclination.
II∧A-Pog (°)	5.9°	1.4°	2 ± 1	Slight retrusion of lower incisors, contributing to balance.
Upper Molar∧Occlusal Plane (°)	0.9°	110.9°	0 ± 1	Improved molar inclination toward a more physiological position.
N-S∧CoP (°)	139.1°	137.3°	122 ± 5	Persistent posterior condylar position, not completely resolved.
S–Co–Go (°)	122.3°	133.3°	143 ± 6	Tendency toward mandibular anterior rotation, favorable for open bite closure.
Go–Me (°)	70.3°	85.3°	73 ± 1.5	Increase in mandibular height, consistent with functional post-treatment adaptation.
Wits (mm)	3.8	2.9	0 ± 2	Overall sagittal improvement with slight residual Class II tendency.

Figure 15

Two images labeled A and B compare test results for muscle activity. Both images feature diagrams of a human head with color-coded areas indicating muscle groups and tables showing test indices, results, and normality ranges. Image A shows a red outline with some values in red, while image B is outlined in green with values indicating normal range. Both include summary conclusions about muscle activity and asymmetry.

4.7.1Final technical comment

The comparative cephalometric analysis reveals a skeletal Class II pattern with slight improvement in mandibular position and a trend toward reduction of the anterior open bite.

The increase in the maxillo-mandibular angle and the greater inclination of the upper incisors indicate effective dentoalveolar compensation. Signs of hyperdivergence and a posteriorly positioned condyle persist; however, the tendency toward mandibular anterior rotation suggests a functionally favorable evolution.

Overall, treatment resulted in improved anterior intercuspation and enhanced facial aesthetics, despite a mild residual skeletal discrepancy.

4.7.2Interpretation

After AMCOP® therapy, surface electromyographic analysis revealed a clear improvement in neuromuscular balance.

Compared with the pre-treatment test, post-treatment data show:

Restoration of barycenter symmetry and reduction of torsion (from 89.21% to within normal range);

Normalization of BAR and IMP values, indicating improved overall muscle coordination and efficiency;

Balanced activity of temporalis and masseter muscles, with asymmetry and torsion indices returning to physiological limits;

Stabilization of global muscular function, as evidenced by normalized electromyographic indices.

These findings confirm the re-establishment of functional harmony between the right and left masticatory chains, supporting the effectiveness of AMCOP® elastodontic therapy in optimizing neuromuscular balance and occlusal stability.

4.8Case 8

S.V. (M) 7 Years: The patient underwent a orthodontic treatment with AMCOP® 3- 55 mm device 1 h per day plus every night, for a total of 10 months. The following cephalometric tracings (Figure 16) with relative pre- and post-treatment values in Table 9, show the pre-treatment and post-treatment conditions, highlighting the improvement in occlusal relationships and vertical dimensions. Surface electromyography (Teethan®) (Figure 17) it was done before and after AMCOP® elastodontic therapy. Post-treatment analysis shows normalization of the muscular barycenter.

Figure 16

Initial (A) and final (B) cephalometry.

Side-by-side lateral cephalometric X-rays of a human skull, labeled A and B. Both images show skeletal structures and soft tissues with superimposed lines and measurements indicating key anatomical landmarks and angles.

Table 9

Comparative cephalometric values (pre- and post-treatment).

Parameter	Pre-treatment	Post-treatment	Reference value (normal range)	Interpretation
SNA (°)	92.4°	90.7°	82 ± 2	Slight reduction of maxillary protrusion; still mildly anterior to cranial base.
SNB (°)	80.8°	82.1°	80 ± 2	Forward repositioning of the mandible toward normal skeletal alignment.
ANB (°)	11.7°	8.6°	2 ± 2	Marked sagittal improvement from skeletal Class II toward Class I relationship.
S-N∧Go-Gn (°) (Mandibular plane angle)	30.5°	29.9°	33 ± 2.5	Vertical control maintained; transition from mild hyperdivergence to normodivergent pattern.
S-NBa (°) (Cranial base angle)	135.0°	—	131 ± 4	Normal cranial base morphology and inclination.
SND (°)	76.7°	—	76 ± 2	Stable mandibular position within normal range.
Upper incisor inclination (+1∧ANS-PNS) (°)	152.6°	89.0°	110 ± 6	Significant correction of upper incisor proclination; upright position achieved.
Lower incisor inclination (−1∧Go-Gn) (°)	86.9°	75.1°	94 ± 7	Marked retroclination of lower incisors; improved dental compensation.
Overjet (mm)	3.5	3.5	3.5 ± 2.5	Maintained within normal limits after alignment.
Overbite (mm)	3.3	3.3	2.5 ± 2.5	Normal vertical overlap preserved.
Interincisal angle (°)	—	166.9°	132 ± 6	Increased interincisal angle, consistent with incisor uprighting and improved esthetics.
Wits appraisal (mm)	−2.4	—	0 ± 2	Within normal range, indicating Class I skeletal balance.
IS–AN∧S (°) (Upper incisor–cranial base angle)	87.0°	—	103 ± 2	Within physiological limits; reflects normalized incisor inclination.
Facial pattern	Hyperdivergent tendency	Normodivergent	—	Vertical growth control achieved during treatment.
Final diagnosis	Skeletal Class II with upper incisor protrusion	Skeletal Class I with normal overjet/overbite and upright incisors	—	Harmonized skeletal and dental relationships; stable occlusal and aesthetic outcome.

Figure 17

Surface electromyographic analysis using the Teethan® system [(A) before treatment; (B) after treatment].

Two clinical charts comparing test results without rollers. Chart A shows a lower test index, posterior barycenter, left-sided muscle predominance, right torsion, and low muscle output. Chart B indicates higher test index, anterior barycenter, muscle balance within normal limits, and symmetry. Both include visual analyses with facial diagrams and numerical data.

4.8.1Clinical interpretation

At the beginning of treatment, patient Gianni presented a skeletal Class II relationship, with a protrusive maxilla (SNA = 92.4°) and a normal mandibular position (SNB = 80.8°). The ANB angle of 11.7° reflected a clear sagittal discrepancy between the jaws. Vertical parameters (S-N∧Go-Gn ≈ 30°) were within the normal range, suggesting a normodivergent facial pattern, not typically associated with open-bite tendencies.

The dentoalveolar analysis showed a marked proclination of upper incisors (IS∧AII = 152.6°) and lower incisor protrusion, producing a reduced interincisal angle and an aesthetic imbalance of the anterior segment.

This dental compensation contributed to the Class II appearance, even in the absence of vertical excess.

4.8.2Post-Treatment changes

After treatment, several favorable skeletal and dental modifications are evident:

The maxilla shows a slight retrusion (SNA decreased by 1.7°),

while the mandible advanced by approximately 1.3° (SNB = 82.1°),

leading to a 3.1° reduction in the ANB angle and a transition toward a skeletal Class I relationship.

The vertical pattern remained stable (S-N∧Go-Gn ≈ 30°), confirming that vertical control was maintained throughout treatment. The most significant change occurred at the dentoalveolar level: the upper incisors were uprighted (89° vs. the pre-treatment 152° angle) and the lower incisors retroclined, resulting in a greater interincisal angle (166.9°) and improved anterior guidance. Overjet and overbite normalized at 3.5 mm, indicating stable and functional occlusion.

4.8.3Post-Treatment open bite findings

After treatment, the patient exhibits stable vertical control and a physiological overbite (3.3 mm).

The mandibular plane angle decreased slightly (−0.6°), suggesting a mild counterclockwise rotation of the mandible a favorable change that tends to close the bite anteriorly. The upper incisors were significantly uprighted (from 152.6° to 89°), which restored proper anterior contact and eliminated the pseudo-open bite component.

No evidence of vertical relapse or hyperdivergent tendency was detected; the patient maintained a normodivergent facial type with balanced lower facial height and functional incisal guidance.

Teethan®-Based Surface EMG Analysis of Dental and Masticatory Muscle Activity

Post-treatment recordings revealed a more centered barycentric distribution, improved coordination between temporalis and masseter muscles, and a noticeable decrease in asymmetry and torsional imbalances.

4.8.4Interpretation

After ten months of AMCOP® TC elastodontic therapy, the patient exhibited:

A uniform and clinically relevant transverse expansion ranging from +4.5 to +4.9 mm across all evaluated regions;

Elimination of the anterior crossbite tendency with enhanced transverse occlusal harmony;

Rebalancing of neuromuscular activity, with normalization of POC, BAR, and TORS parameters.

Overall, the improvement in muscular coordination and interarch relationships confirms the orthopedic and functional effectiveness of AMCOP® Class III elastodontic treatment in promoting harmonious craniofacial growth.

4.9Case 9

P.L. (M) 7 Years: The patient underwent a 12-month orthodontic treatment using the AMCOP® Open 3, (55 mm) device. The following cephalometric tracings (Figure 18) with relative pre- and post-treatment values in Table 10, show the pre-treatment and post-treatment conditions, highlighting the improvement in occlusal relationships and vertical dimensions. Surface electromyography (Teethan®) (Figure 19) it was done before and after AMCOP® elastodontic therapy. Post-treatment analysis shows normalization of the muscular barycenter.

Figure 18

Initial (A) and final (B) cephalometry.

Two lateral cephalometric X-rays show a human skull with diagrams overlaid. Image A displays skeletal and dental anatomy with measurement lines. Image B includes similar skeletal outlines with annotations indicating different angles and measurements. Both images have scales on the side for reference.

Table 10

Cephalometric comparison report: pre (A) and post (B) treatment.

Parameter	Pre-treatment	Post-treatment	Reference range	Clinical comment
SNA (°)	89.0	86.0	82 ± 2	Maxilla slightly protrusive initially, normalized post-treatment
SNB (°)	75.2	78.0	80 ± 2	Mandible retruded initially, improved after treatment
ANB (°)	13.8	8.0	2 ± 2	Skeletal Class II tendency reduced after treatment
SN-GoGn (°)	44.7	38.0	32 ± 5	Vertical growth pattern decreased, improving open bite tendency
SN-MP (°)	44.7	38.0	32 ± 5	Mandibular plane angle decreased, better vertical control
S-N^A (°)	89.0	86.0	82 ± 2	Upper jaw position normalized
S-N^B (°)	75.2	78.0	80 ± 2	Mandible advanced anteriorly
U1 to NA (°)	−5.4	21.0	22 ± 6	Upper incisors retroclined initially, uprighted post-treatment
L1 to NB (°)	3.9	20.0	25 ± 6	Lower incisors retroclined initially, improved alignment
Interincisal Angle (°)	171.7	135.0	130 ± 5	Severe incisor retroclination corrected
GoMe-SN (°)	44.5	38.5	32 ± 5	Improved mandibular plane angle—better bite closure
Wits (mm)	1.3	0.0	0 ± 2	Skeletal Class II improved toward normal

Figure 19

Teethan® surface electromyography. (A) Pre-treatment and (B) post-treatment.

Panel A and B show diagrams of human heads with color-coded sections and tables of data. The diagrams illustrate the temporalis (TA) and masseters (MM) muscles. Panel A, outlined in red, shows test scores below normal limits in red. Panel B, outlined in green, shows higher test scores in black. Both panels include symmetry assessments and conclusions indicating centering, asymmetry, and muscle coordination findings.

4.9.1Final comment

The cephalometric comparison shows significant improvement in the vertical and sagittal skeletal relationships. Initially, the patient exhibited a hyperdivergent skeletal pattern with mandibular retrusion and retroclined incisors, which contributed to an anterior open bite. Post-treatment, there is a clear reduction of the mandibular plane angle, forward positioning of the mandible, and normalization of incisor inclination. These changes indicate successful vertical control and bite closure, achieving functional and esthetic improvement consistent with open bite correction in an adult patient.

Teethan®-Based Surface EMG Analysis of Dental and Masticatory Muscle Activity

4.9.2Interpretation

After 12 months of treatment with the AMCOP® Class III elastodontic appliance, the patient showed:

A clear transverse widening of the upper arch, particularly in the premolar region (+5.4 mm);

Functional correction of anterior maxillary deficiency;

Repositioning of the muscular barycenter and restoration of bilateral symmetry;

A substantial increase in neuromuscular performance (IMP improved from 23.8% to 95.6%);

Stable occlusal and muscular coordination, reflecting functional adaptation.

Overall, the findings confirm the effectiveness of early AMCOP® Class III therapy in promoting balanced transverse development and neuromuscular stabilization during growth.

5Discussion

Early orthodontic intervention plays a crucial role in the effective management of malocclusions and associated orofacial dysfunctions (48, 109–112). A significant advancement in this field is represented by the development of Cranio-Occlusal-Postural Multifunctional Harmonizers (AMCOP® bioactivators) (4, 113–116). These appliances incorporate elastodontic principles that emphasize neuromuscular function to correct skeletal, dental, and muscular imbalances, thereby promoting ideal dental alignment and harmonious maxillary-mandibular growth (117–124). By improving tongue posture and swallowing function, AMCOP® bioactivators are particularly effective in the treatment of Class I, II, and III malocclusions, atypical swallowing, and related muscular dysfunctions (125–129). Their non-invasive design, combined with minimal discomfort and ease of use, ensures superior patient compliance compared with more conventional appliances such as Twin Blocks or Activators (130–133). These devices are suitable for both children and adults, as they reduce overall treatment time and provide flexibility throughout the various stages of therapy (60, 134–136 ). One of the major strengths of AMCOP® bioactivators lies in their ability to promote transverse development, achieved using a dedicated occlusal plane and a special elastomeric compound designed to act synergistically on skeletal structures, teeth, and musculature (137–147). In the presented cases, the clinical protocol initially involved the use of the AMCOP® Open appliance, which allowed targeted correction of transverse and vertical dimensions. This improvement was confirmed by comparative digital model analysis and cephalometric tracing, which documented the progression of therapy and the resolution of sagittal discrepancies (148–150). A common clinical error is to employ a Class-specific elastodontic appliance before addressing transverse discrepancies. In this protocol, the AMCOP® Open appliance was used for approximately nine months, followed by a Class-specific device to refine sagittal correction. The total treatment duration was approximately sixteen months. The appliance was worn for one hour during the day and passively throughout the night, without additional myofunctional exercises, since the act of swallowing itself provides sufficient and physiologically appropriate activation for therapeutic efficacy (62, 148–158). A major limitation of this study is the lack of a control group, which prevents definitive attribution of the observed changes exclusively to AMCOP® therapy. Since the sample consisted of growing patients, part of the improvements may reflect physiological craniofacial growth or spontaneous functional adaptation. Therefore, the present findings should be considered preliminary and hypothesis-generating. Controlled prospective studies are required to isolate treatment effects from growth-related changes.

6Conclusions

AMCOP® elastodontic therapy was associated with clinically meaningful improvements in vertical skeletal relationships and neuromuscular coordination in a pediatric population treated during active growth. Cephalometric analysis showed closure or reduction of anterior open bite, improved control of mandibular plane inclination, normalization of intermaxillary divergence, and more physiological incisor inclinations with improved overjet/overbite. Parallel sEMG findings, including normalization of the functional barycenter, reduction of torsion and asymmetry, and increased impact/efficiency indices, suggest a favorable neuromuscular rebalancing rather than purely dentoalveolar camouflage. The staged protocol (initial Open phase to recover transverse and vertical corridors, followed by class-oriented refinement when indicated) proved well tolerated, minimally invasive, and compatible with high compliance. No relevant adverse events were recorded. However, this work represents a preliminary pilot case series with a small sample size and a retrospective single-arm design. Therefore, conclusions must be interpreted with caution, and no definitive causal inference can be drawn. From a clinical perspective, these preliminary findings support the potential role of early interceptive treatment integrating orthopedic guidance and neuromuscular rehabilitation in selected growing patients, particularly those at risk of vertical relapse. Future prospective controlled trials with larger samples and long-term follow-up are warranted to confirm treatment effectiveness and stability. Nevertheless, the retrospective single-arm design and the absence of an untreated or alternative-appliance control group represent a major limitation that substantially limits causal inference.

Data availability statement

The original contributions presented in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding author/s.

Ethics statement

The studies involving humans were approved by Declaration of Helsinki and approved by the Ethics Committee of Policlinico of Bari (Prot. Number: 971, Prot. 2427/CEL., Approved date: 1 October 2025, U.O. di Odontostomatologia. Principal investigator: Prof. F. Inchingolo, U.O. di Odontostomatologia, University Polyclinic of Bari). The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation in this study was provided by the participants' legal guardians/next of kin. Written informed consent was obtained from the individual(s), and minor(s)' legal guardian/next of kin, for the publication of any potentially identifiable images or data included in this article.

Author contributions

GD: Writing – original draft. GM: Writing – original draft. AD: Writing – original draft. LF: Writing – original draft. FC: Writing – review & editing. FI: Writing – review & editing. AP: Writing – review & editing. DD: Writing – original draft. AnI: Writing – review & editing. AlI: Writing – review & editing.

Conflict of interest

The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Generative AI statement

The author(s) declared that generative AI was not used in the creation of this manuscript.

Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

References 1.

Fields

Proffit

Nixon

Phillips

Stanek

. Facial pattern differences in long-faced children and adults. Am J Orthod. (1984) 85:217–23. 10.1016/0002-9416(84)90061-7

6608274

Nanda

. Patterns of vertical growth in the face. Am J Orthod Dentofacial Orthop. (1988) 93:103–16. 10.1016/0889-5406(88)90287-9

3422525

Nahoum

. Vertical proportions: a guide for prognosis and treatment in anterior open-bite. Am J Orthod. (1977) 72:128–46. 10.1016/0002-9416(77)90055-0

268145

Subtelny

Sakuda

. Open-Bite: diagnosis and treatment. Am J Orthod. (1964) 50:337–58. 10.1016/0002-9416(64)90175-7

Sassouni

. A classification of skeletal facial types. Am J Orthod. (1969) 55:109–23. 10.1016/0002-9416(69)90122-5

5249177

Siriwat

Jarabak

. Malocclusion and facial morphology is there a relationship? An epidemiologic study. Angle Orthod. (1985) 55:127–38. 10.1043/0003-3219(1985)055/3C0127:MAFMIT/3E2.0.CO;2

3874569

Cangialosi

. Skeletal morphologic features of anterior open bite. Am J Orthod. (1984) 85:28–36. 10.1016/0002-9416(84)90120-9

6581725

Sassouni

Nanda

. Analysis of dentofacial vertical proportions. Am J Orthod. (1964) 50:801–23. 10.1016/0002-9416(64)90039-9

Simion

Rocchietta

Kim

Nevins

Fiorellini

. Vertical ridge augmentation by means of deproteinized bovine bone block and recombinant human platelet-derived growth factor-BB: a histologic study in a dog model. Int J Periodontics Restorative Dent. (2006) 26:415–23.17073351

10.

Inchingolo

Maino

Gatti

Tricarico

Nardella

Grazioli

Gadoxetic acid magnetic-enhanced resonance imaging in the diagnosis of cholangiocarcinoma. World J Gastroenterol. (2020) 26:4261–71. 10.3748/wjg.v26.i29.4261

32848332

11.

Arulselvan

Fard

Tan

Gothai

Fakurazi

Norhaizan

Role of antioxidants and natural products in inflammation. Oxid Med Cell Longev. (2016) 2016:5276130. 10.1155/2016/5276130

27803762

12.

Malcangi

Patano

Morolla

De Santis

Piras

Settanni

Analysis of dental enamel remineralization: a systematic review of technique comparisons. Bioengineering. (2023) 10:472. 10.3390/bioengineering10040472

37106659

13.

Coloccia

Inchingolo

Malcangi

Montenegro

Patano

Effectiveness of dental and maxillary transverse changes in tooth-borne, bone-borne, and hybrid palatal expansion through cone-beam tomography: a systematic review of the literature. Medicina. (2021) 57:288. 10.3390/medicina57030288

33808680

14.

Vaid

Sabouni

Wilmes

Bichu

Thakkar

Adel

. Customized adjuncts with clear aligner therapy: “the golden circle model” explained!. J World Fed Orthod. (2022) 11:216–25. 10.1016/j.ejwf.2022.10.005

36400659

15.

Sabouni

Muthuswamy Pandian

Vaid

Adel

. Distalization using efficient attachment protocol in clear aligner therapy—a case report. Clin Case Rep. (2023) 11:e6854. 10.1002/ccr3.6854

36698525

16.

Yan

Zhang

Ren

Yang

Wang

Gao

Effectiveness of clear aligners in achieving proclination and intrusion of incisors among class II division 2 patients: a multivariate analysis. Prog Orthod. (2023) 24:12. 10.1186/s40510-023-00463-6

37009943

17.

Patel

. Invisalign Case Study Part One: The Deep Bite—dentistry Online. Dentistry.co.uk (2021).

18.

Cui

J-Y

Ting

Cao

Y-X

Sun

D-X

Bing

X-P

. Morphology changes of maxillary molar distalization by clear aligner therapy. Int J Morphol. (2022) 40:920–6. 10.4067/S0717-95022022000400920

19.

D’Antò

Valletta

Ferretti

Bucci

Kirlis

Rongo

. Predictability of maxillary molar distalization and derotation with clear aligners: a prospective study. Int J Environ Res Public Health. (2023) 20:2941. 10.3390/ijerph20042941

20.

Erdinç

Ugur

Erbay

. A comparison of different treatment techniques for posterior crossbite in the mixed dentition. Am J Orthod Dentofacial Orthop. (1999) 116:287–300. 10.1016/s0889-5406(99)70240-4

21.

Halicioğlu

Yavuz

. A comparison of the sagittal and vertical dentofacial effects of maxillary expansion produced by a memory screw and a hyrax screw. Aust Orthod J. (2016) 32:31–40. 10.21307/aoj-2020-110

22.

Manzella

Warunek

Conley

Al-Jewair

. A controlled clinical study of the effects of the Ni-Ti Memoria® leaf spring activated expander. Aust Orthod J. (2018) 34:196–204. 10.21307/aoj-2020-071

23.

Ugolini

Cossellu

Farronato

Silvestrini-Biavati

Lanteri

. A multicenter, prospective, randomized trial of pain and discomfort during maxillary expansion: leaf expander versus hyrax expander. Int J Paediatr Dent. (2020) 30:421–8. 10.1111/ipd.12612

31894603

24.

Bavetta

Randazzo

Cavataio

Paderni

Grassia

A retrospective study on insertion torque and implant stability quotient (ISQ) as stability parameters for immediate loading of implants in fresh extraction sockets. Biomed Res Int. (2019) 2019:9720419. 10.1155/2019/9720419

31781659

25.

Timms

. A study of basal movement with rapid maxillary expansion. Am J Orthod. (1980) 77:500–7. 10.1016/0002-9416(80)90129-3

6989258

26.

Baccetti

Franchi

McNamara

. An improved version of the cervical vertebral maturation (CVM) method for the assessment of mandibular growth. Angle Orthod. (2002) 72:316–23. 10.1043/0003-3219(2002)072/3C0316:AIVOTC/3E2.0.CO;2

12169031

27.

d'Apuzzo

Nucci

Strangio

Inchingolo

Dipalma

Minervini

Applied Sciences | Free Full-Text | Dento-Skeletal Class III Treatment with Mixed Anchored Palatal Expander: A Systematic Review. Available online at:

https://www.mdpi.com/2076-3417/12/9/4646

(Accessed June 27, 2023).

28.

Inchingolo

Tatullo

Abenavoli

Marrelli

Inchingolo

Corelli

Surgical treatment of depressed scar: a simple technique. Int J Med Sci. (2011) 8:377–9. 10.7150/ijms.8.377

21698056

29.

Inchingolo

Tatullo

Pacifici

Gargari

Inchingolo

Use of dermal-fat grafts in the post-oncological reconstructive surgery of atrophies in the zygomatic region: clinical evaluations in the patients undergone to previous radiation therapy. Head Face Med. (2012) 8:33. 10.1186/1746-160X-8-33

23217096

30.

Inchingolo

Tatullo

Abenavoli

Marrelli

Inchingolo

Comparison between traditional surgery, CO2 and nd:yag Laser treatment for generalized gingival hyperplasia in sturge-weber syndrome: a retrospective study. J Investig Clin Dent. (2010) 1:85–9. 10.1111/j.2041-1626.2010.00020.x

25427262

31.

Inchingolo

Ceci

Patano

Inchingolo

Montenegro

Di Pede

Elastodontic therapy of hyperdivergent class II patients using AMCOP® devices: a retrospective study. Appl Sci. (2022) 12:3259. 10.3390/app12073259

32.

McNamara

. Maxillary transverse deficiency. Am J Orthod Dentofacial Orthop. (2000) 117:567–70. 10.1016/s0889-5406(00)70202-2

10799117

33.

Inchingolo

Santacroce

Cantore

Ballini

Del Prete

Topi

Probiotics and EpiCor® in human health. J Biol Regul Homeost Agents. (2019) 33:1973–9. 10.23812/19-543-L

31858774

34.

Patano

Cirulli

Beretta

Plantamura

Inchingolo

Education technology in orthodontics and paediatric dentistry during the COVID-19 pandemic: a systematic review. Int J Environ Res Public Health. (2021) 18:6056. 10.3390/ijerph18116056

34199882

35.

Cozza

Baccetti

Franchi

Mucedero

Polimeni

. Sucking habits and facial hyperdivergency as risk factors for anterior open bite in the mixed dentition. Am J Orthod Dentofacial Orthop. (2005) 128:517–9. 10.1016/j.ajodo.2005.04.032

16214636

36.

Warren

Slayton

Bishara

Levy

Yonezu

Kanellis

. Effects of nonnutritive sucking habits on occlusal characteristics in the mixed dentition. Pediatr Dent. (2005) 27:445–50.16532883

37.

Ciavarella

Tepedino

Laurenziello

Guida

Troiano

Montaruli

Swallowing and temporomandibular disorders in adults. J Craniofac Surg. (2018) 29:e262–7. 10.1097/SCS.0000000000004376

29554061

38.

Inchingolo

Campanelli

Carpentiere

de Ruvo

Ferrante

Orthodontic treatment in patients with atypical swallowing and malocclusion: a systematic review. J Clin Pediatr Dent. (2024) 48:14–26. 10.22514/jocpd.2024.100

39275817

39.

Hanson

. A review of: variation of swallowing patterns with malocclusions, by Ibrahim A. Nashashibi (1987). Int J Orofac Myol. (1988) 14(2):17. 10.52010/ijom.1988.14.2.6

40.

Ngan

Fields

. Open bite: a review of etiology and management. Pediatr Dent. (1997) 19:91–8.9106869

41.

Graber

Vanarsdall

RL, Jr.

Vig

KWL

Huang

. Orthodontics: current principles and techniques. J Indian Orthod Soc. (2017) 51(2):141. 10.4103/0301-5742.204613

42.

Lentini-Oliveira

Carvalho

Rodrigues

Prado

LBF

Prado

Orthodontic and orthopaedic treatment for anterior open bite in children. Cochrane Database Syst Rev. (2014) 2014:CD005515. 10.1002/14651858.CD005515.pub3

25247473

43.

Bonnet

. Un appareil de reposturation : l’Enveloppe Linguale nocturne (E.L.N.). Rev Orthop Dento Faciale. (1992) 26:329–47. 10.1051/odf/1992025

44.

Seehra

Fleming

Mandall

DiBiase

. A comparison of two different techniques for early correction of class III malocclusion. Angle Orthod. (2012) 82:96–101. 10.2319/032011-197.1

21806467

45.

Giuntini

McNamara

Franchi

. Treatment of class II malocclusion in the growing patient: early or late? Semin Orthod. (2023) 29:183–8. 10.1053/j.sodo.2023.04.008

46.

Artese

Fernandes

LQP

de Oliveira Caetano

Miguel

JAM

. Early treatment for anterior open bite: choosing adequate treatment approaches. Semin Orthod. (2023) 29:207–15. 10.1053/j.sodo.2023.06.001

47.

Chandra

Jha

. Early management of class III malocclusion in mixed dentition. Int J Clin Pediatr Dent. (2021) 14:331–4. 10.5005/jp-journals-10005-1752

34413617

48.

Zhou

Duan

Song

Liu

Expert consensus on pediatric orthodontic therapies of malocclusions in children. Int J Oral Sci. (2024) 16:32. 10.1038/s41368-024-00299-8

38627388

49.

Baneshi

O’malley

El-angbawi

Thiruvenkatachari

. Effectiveness of clear orthodontic aligners in correcting malocclusions: a systematic review and meta-analysis. J Evid Based Dent Pract. (2025) 25:102081. 10.1016/j.jebdp.2024.102081

39947778

50.

Krishnaswamy

. Vertical control with TADs: procedures and protocols. Semin Orthod. (2018) 24:108–22. 10.1053/j.sodo.2018.01.010

51.

Ghafari

Haddad

. Open bite: spectrum of treatment potentials and limitations. Semin Orthod. (2013) 19:239–52. 10.1053/j.sodo.2013.07.007

52.

Serafin

Fastuca

Caprioglio

. CBCT Analysis of dento-skeletal changes after rapid versus slow maxillary expansion on deciduous teeth: a randomized clinical trial. J Clin Med. (2022) 11:4887. 10.3390/jcm11164887

36013125

53.

Lanteri

Abate

Cavagnetto

Ugolini

Gaffuri

Gianolio

Cephalometric changes following maxillary expansion with Ni-Ti leaf springs palatal expander and rapid maxillary expander: a retrospective study. Appl Sci. (2021) 11:5748. 10.3390/app11125748

54.

Kuroda

Sugawara

Deguchi

Kyung

H-M

Takano-Yamamoto

. Clinical use of miniscrew implants as orthodontic anchorage: success rates and postoperative discomfort. Am J Orthod Dentofacial Orthop. (2007) 131:9–15. 10.1016/j.ajodo.2005.02.032

17208101

55.

Mummolo

Marchetti

Albani

Campanella

Pugliese

Di Martino

Comparison between rapid and slow palatal expansion: evaluation of selected periodontal indices. Head Face Med. (2014) 10:30. 10.1186/1746-160X-10-30

25128278

56.

Lanteri

Cossellu

Gianolio

Beretta

Lanteri

Cherchi

Comparison between RME, SME and leaf expander in growing patients: a retrospective postero-anterior cephalometric study. Eur J Paediatr Dent. (2018) 19:199–204. 10.23804/ejpd.2018.19.03.6

30063151

57.

Nieri

Paoloni

Lione

Barone

Marino Merlo

Giuntini

Comparison between two screws for maxillary expansion: a multicenter randomized controlled trial on patient’s reported outcome measures. Eur J Orthod. (2021) 43:293–300. 10.1093/ejo/cjaa063

33215652

58.

Yılmaz

Arman-Özçırpıcı

Erken

Polat-Özsoy

. Comparison of short-term effects of Mini-implant-supported maxillary expansion appliance with two conventional expansion protocols. Eur J Orthod. (2015) 37:556–64. 10.1093/ejo/cju094

59.

Paoloni

Giuntini

Lione

Nieri

Barone

Merlo

Comparison of the dento-skeletal effects produced by leaf expander versus rapid maxillary expander in prepubertal patients: a two-center randomized controlled trial. Eur J Orthod. (2022) 44:163–9. 10.1093/ejo/cjab035

34114608

60.

Ortu

Di Nicolantonio

Cova

Pietropaoli

De Simone

Monaco

. Efficacy of elastodontic devices in temporomandibular disorder reduction assessed by computer aid evaluation. Appl Sci. (2024) 14:1651. 10.3390/app14041651

61.

Dipalma

Inchingolo

Cardarelli

Di Lorenzo

Viapiano

Ferrante

Effects of AMCOP® Elastodontic Devices on Skeletal Divergence and Airway Dimensions in Growing Patients. Available online at:

https://www.mdpi.com/2077-0383/14/15/5297

(Accessed November 5, 2025).

62.

Inchingolo

Patano

Coloccia

Ceci

Inchingolo

Marinelli

The efficacy of a new AMCOP® elastodontic protocol for orthodontic interceptive treatment: a case series and literature overview. Int J Environ Res Public Health. (2022) 19:988. 10.3390/ijerph19020988

35055811

63.

Pennacchio

BFP

Giorgio

Cardarelli

Sguera

Vecchio

Memè

AMCOP Bio-Activators: an innovative solution in interceptive orthodontics for the treatment of malocclusions and orofacial dysfunctions. Oral Implantol (Rome). (2024) 16:162–75. 10.11138/oi163.1suppl162-175

64.

Manfredini

Ahlberg

Lobbezoo

. Bruxism definition: past, present, and future – what should a prosthodontist know? J Prosthet Dent. (2022) 28(5):905–12. 10.1016/j.prosdent.2021.01.026

65.

Kaur

Soni

Prashar

Bansal

Brar

Kaur

. Functional appliances. Indian J Dent Sci. (2017) 9:276. 10.4103/IJDS.IJDS_65_16

66.

Inchingolo

Trilli

Ferrante

Di Noia

de Ruvo

Orthopedic devices for skeletal class III malocclusion treatment in growing patients: a comparative effectiveness systematic review. J Clin Med. (2024) 13:7141. 10.3390/jcm13237141

39685600

67.

Gawali

Shah

Gowdar

Bhavsar

Giri

Laddha

. The evolution of digital dentistry: a comprehensive review. J Pharm Bioallied Sci. (2024) 16:S1920–1922. 10.4103/jpbs.jpbs_11_24

39346228

68.

Panayi

Efstathiou

Christopoulou

Kotantoula

Tsolakis

. Digital orthodontics: present and future. AJO-DO Clin Companion. (2024) 4:14–25. 10.1016/j.xaor.2023.12.001

69.

Davidovitch

Krishnan

. Role of basic biological sciences in clinical orthodontics: a case series. Am J Orthod Dentofacial Orthop. (2009) 135:222–31. 10.1016/j.ajodo.2007.03.028

19201330

70.

Reitan

. Tissue behavior during orthodontic tooth movement. Am J Orthod. (1960) 46:881–900. 10.1016/0002-9416(60)90091-9

71.

Huettner

Young

. The movability of vital and devitalized teeth in the macacus rhesus monkey. Am J Orthod. (1955) 41:594–603. 10.1016/0002-9416(55)90211-6

72.

Tomášik

Zsoldos

Oravcová

Lifková

Pavleová

Strunga

AI And face-driven orthodontics: a scoping review of digital advances in diagnosis and treatment planning. AI. (2024) 5:158–76. 10.3390/ai5010009

73.

Ramdan

. Digital orthodontics: an overview. MSA Dent J. (2023) 2:26–30. 10.21608/msadj.2023.211756.1020

74.

Liao

Zhou

Gong

The role of emerging digital technologies in revolutionizing dental education: a bibliometric analysis. J Dent Educ. (2025) 60(29):16044–50. 10.1002/jdd.70033

75.

Inchingolo

Patano

Inchingolo

Riccaldo

Morolla

Netti

Analysis of mandibular muscle variations following condylar fractures: a systematic review. J Clin Med. (2023) 12(18):5925. 10.3390/jcm12185925

37762866

76.

Nulton

Olex

Dozmorov

Morgan

Windle

. Analysis of the cancer genome atlas sequencing data reveals novel properties of the human papillomavirus 16 genome in head and neck squamous cell carcinoma. Oncotarget. (2017) 8:17684–99. 10.18632/oncotarget.15179

28187443

77.

Arrigoni

Ballini

Santacroce

Cantore

Inchingolo

Another Look at dietary polyphenols: challenges in cancer prevention and treatment. Curr Med Chem. (2022) 29:1061–82. 10.2174/0929867328666210810154732

34375181

78.

Sebastian

Babu

Prathibha

Hariharan

Pillai

. Anterior tongue cancer with No history of tobacco and alcohol use may be a distinct molecular and clinical entity. J Oral Pathol Med. (2014) 43:593–9. 10.1111/jop.12175

24809775

79.

Makarewicz

Kaźmierczak-Siedlecka

Sobocki

Dobrucki

Kalinowski

Stachowska

. Anti-cancer management of head and neck cancers and oral microbiome—what can we clinically obtain? Front Cell Infect Microbiol. (2024) 14:1329057. 10.3389/fcimb.2024.1329057

38481661

80.

De Gabriele

Dallatana

Riva

Vasudavan

Wilmes

. The easy driver for placement of palatal Mini-implants and a maxillary expander in a single appointment. J Clin Orthod. (2017) 51:728–37.29360638

81.

Inchingolo

Latini

Palmieri

Di Pede

Trilli

Application of graphene oxide in oral surgery: a systematic review. Materials. (2023) 16:6293. 10.3390/ma16186293

37763569

82.

Dipalma

Inchingolo

Piras

Carpentiere

Garofoli

Artificial intelligence and its clinical applications in orthodontics: a systematic review. Diagnostics. (2023) 13:3677. 10.3390/diagnostics13243677

38132261

83.

Bartemes

Gochanour

Routman

Doering

Burger

Assessing the capacity of methylated DNA markers of cervical squamous cell carcinoma to discriminate oropharyngeal squamous cell carcinoma in human papillomavirus mediated disease. Oral Oncol. (2023) 146:106568. 10.1016/j.oraloncology.2023.106568

37717549

84.

Inchingolo

Latini

Ferrante

Trilli

Del Vecchio

Oxidative stress and natural products in orthodontic treatment: a systematic review. Nutrients. (2024) 16:113. 10.3390/nu16010113

85.

Inchingolo

Fatone

Avantario

Del Vecchio

Pezzolla

Management of rheumatoid arthritis in primary care: a scoping review. Int J Environ Res Public Health. (2024) 21:662. 10.3390/ijerph21060662

38928909

86.

Cruz

Lemos

CAA

de Luna Gomes

Fernandes e Oliveira

Pellizzer

Verri

. Clinical comparison between crestal and subcrestal dental implants: a systematic review and meta-analysis. J Prosthet Dent. (2022) 127:408–17. 10.1016/j.prosdent.2020.11.003

33358610

87.

Heintze

Rousson

Hickel

. Clinical effectiveness of direct anterior restorations—a meta-analysis. Dent Mater. (2015) 31:481–95. 10.1016/j.dental.2015.01.015

25773188

88.

Pilloni

Rojas

Trezza

Carere

De Filippis

Marsala

Clinical effects of the adjunctive use of a polynucleotide and hyaluronic acid-based gel in the subgingival re-instrumentation of residual periodontal pockets: a randomized, split-mouth clinical trial. J Periodontol. (2023) 94(3):354–63. 10.1002/JPER.22-0225

36189651

89.

Pilloni

Rojas

Trezza

Carere

De Filippis

Marsala

Clinical Effects of the Adjunctive Use of Polynucleotide and Hyaluronic Acid-based Gel in the Subgingival Re-instrumentation of Residual Periodontal Pockets: A Randomized, Split-mouth Clinical Trial—Pilloni—2023—Journal of Periodontology—Wiley Online Library. Available online at:

https://aap.onlinelibrary.wiley.com/doi/10.1002/JPER.22-0225

(Accessed March 9, 2025).

90.

Tadakamadla

Bharathwaj

Duraiswamy

Sforza

Tartaglia

. Clinical efficacy of a new cetylpyridinium chloride-hyaluronic acid–based mouthrinse compared to chlorhexidine and placebo mouthrinses—a 21-day randomized clinical trial. Int J Dent Hyg. (2020) 18:116–23. 10.1111/idh.12413

31276312

91.

Das

Panda

Greco Lucchina

Mohanty

Manfredi

Clinical efficacy of grape seed extract as an adjuvant to scaling and root planing in treatment of periodontal pockets. J Biol Regul Homeost Agents. (2021) 35:89–96. 10.23812/21-2supp1-8

34281305

92.

Sandalli

Cildir

Guler

. Clinical investigation of traumatic injuries in yeditepe university, Turkey during the last 3 years. Dent Traumatol. (2005) 21:188–94. 10.1111/j.1600-9657.2005.00309.x

16026523

93.

Pilloni

Marini

Gagliano

Canciani

Dellavia

Cornaghi

Clinical, histological, immunohistochemical, and biomolecular analysis of hyaluronic acid in early wound healing of human gingival tissues: a randomized, split-mouth trial. J Periodontol. (2023) 94:868–81. 10.1002/JPER.22-0338

36648006

94.

Paolantonio

D’Ercole

Pilloni

D’Archivio

Lisanti

Graziani

Clinical, microbiologic, and biochemical effects of subgingival administration of a Xanthan-based chlorhexidine gel in the treatment of periodontitis: a randomized multicenter trial. J Periodontol. (2009) 80:1479–92. 10.1902/jop.2009.090050

19722799

95.

Garbarino

Lanteri

Durando

Magnavita

Sannita

. Co-morbidity, mortality, quality of life and the healthcare/welfare/social costs of disordered sleep: a rapid review. Int J Environ Res Public Health. (2016) 13:831. 10.3390/ijerph13080831

27548196

96.

Gunjal

Pateel

DGS

. Comparative effectiveness of propolis with chlorhexidine mouthwash on gingivitis—a randomized controlled clinical study. BMC Complement Med Ther. (2024) 24:154. 10.1186/s12906-024-04456-8

38582863

97.

Bolcato

Franzetti

Fassina

Basile

Martinez

Tronconi

. Comparative study on informed consent regulation in health care among Italy, France, United Kingdom, nordic countries, Germany, and Spain. J Forensic Leg Med. (2024) 103:102674. 10.1016/j.jflm.2024.102674

38502996

98.

Aparna

Naik

Goud Padala

Malshetwar

Kothamasu

. Vertical dysplasia. Int Dent J Stud Res. (2024) 12:110–6. 10.18231/j.idjsr.2024.022

99.

El Guennouni

Houb-Dine

Ben Mohimd

Zaoui

. Orthodontic treatment of deep bite in mixed dentition and/or early permanent dentition: what about stability?—a systematic review. Int Orthod. (2025) 23:100956. 10.1016/j.ortho.2024.100956

39742828

100.

4. Management of Vertical Discrepancies (2) 2 | PDF | Orthodontics | Tooth. Available online at:

https://it.scribd.com/presentation/415147508/4-Management-of-Vertical-Discrepancies-2-2

(Accessed November 5, 2025).

101.

Keski-Nisula

Hernesniemi

Heiskanen

Keski-Nisula

Varrela

. Orthodontic intervention in the early mixed dentition: a prospective, controlled study on the effects of the eruption guidance appliance. Am J Orthod Dentofacial Orthop. (2008) 133:254–60; quiz 328.e2. 10.1016/j.ajodo.2006.05.039

18249292

102.

Rozzi

Alesi

Mucedero

Cozza

. Dentoskeletal effects of rapid maxillary expander therapy in early mixed dentition patients with different vertical growing patterns without posterior crossbite: a retrospective study. Am J Orthod Dentofacial Orthop. (2023) 163:319–27. 10.1016/j.ajodo.2021.11.018

36443147

103.

Dipalma

Inchingolo

Cardarelli

Di Lorenzo

Viapiano

Ferrante

Effects of AMCOP® elastodontic devices on skeletal divergence and airway dimensions in growing patients. J Clin Med. (2025) 14:5297. 10.3390/jcm14155297

40806919

104.

Shapiro

. Stability of open bite treatment. Am J Orthod Dentofacial Orthop. (2002) 121:566–8. 10.1067/mod.2002.124175

12080301

105.

Kim

. Anterior openbite and its treatment with multiloop edgewise archwire. Angle Orthod. (1987) 57:290–321. 10.1043/0003-3219(1987)057/3C0290:AOAITW/3E2.0.CO;2

3479033

106.

Nasry

Barclay

. Periodontal lesions associated with deep traumatic overbite. Br Dent J. (2006) 200:557–61; quiz 588. 10.1038/sj.bdj.4813587

16732243

107.

Proffit

. The timing of early treatment: an overview. Am J Orthod Dentofacial Orthop. (2006) 129:S47–49. 10.1016/j.ajodo.2005.09.014

16644417

108.

Harris

Butler

. Patterns of incisor root resorption before and after orthodontic correction in cases with anterior open bites. Am J Orthod Dentofacial Orthop. (1992) 101:112–9. 10.1016/0889-5406(92)70002-R

1739065

109.

Kaje

Rashme

Manimegalan

Vundela

Saidalavi

Jadhav

. Assessing the efficacy of early versus late orthodontic intervention in the management of class II malocclusion: a comparative analysis. J Pharm Bioallied Sci. (2024) 16:S2691–3. 10.4103/jpbs.jpbs_370_24

39346279

110.

Valério

Poklepović Peričić

Rossi

Grippau

Tavares Campos

JDS

Borges Do Nascimento

. The effectiveness of early intervention on malocclusion and its impact on craniofacial growth: a systematic review. Contemp Pediatr Dent. (2021) 2:1–18. 10.51463/cpd.2021.61

111.

Mangano

. Digital dentistry. J Dent. (2021) 109:103693. 10.1016/j.jdent.2021.103693

34004272

112.

Genovese

Giambò

Abramo

Mancini

Pastore

D’Amico

. Advancements and applications in digital dentistry: a scoping review. In: Badnjević

Gurbeta Pokvić

, editors. Proceedings of the MEDICON’23 and CMBEBIH’23. Cham: Springer Nature Switzerland (2024). p. 702–9.

113.

Hellman

. Open-Bite. Int J Orthodontia Oral Surg Radiogr. (1931) 17:421–44. 10.1016/S0099-6963(31)80143-7

114.

Matsumoto

MAN

Romano

Ferreira

JTL

Valério

. Open bite: diagnosis, treatment and stability. Braz Dent J. (2012) 23:768–78. 10.1590/S0103-64402012000600024

23338275

115.

Xun

Zeng

Wang

. Microscrew anchorage in skeletal anterior open-bite treatment. Angle Orthod. (2007) 77:47–56. 10.2319/010906-14R.1

17029531

116.

Sugawara

Baik

Umemori

Takahashi

Nagasaka

Kawamura

Treatment and posttreatment dentoalveolar changes following intrusion of mandibular molars with application of a skeletal anchorage system (SAS) for open bite correction. Int J Adult Orthodon Orthognath Surg. (2002) 17:243–53.12592995

117.

Jedliński

Mazur

Grocholewicz

Janiszewska-Olszowska

. 3D Scanners in orthodontics—current knowledge and future perspectives—a systematic review. Int J Environ Res Public Health. (2021) 18:1121. 10.3390/ijerph18031121

118.

Rossini

Parrini

Castroflorio

Deregibus

Debernardi

. Efficacy of clear aligners in controlling orthodontic tooth movement: a systematic review. Angle Orthod. (2015) 85(5):881–9. 10.2319/061614-436.1

25412265

119.

Bondemark

. A comparative analysis of distal maxillary molar movement produced by a new lingual intra-arch Ni-Ti coil appliance and a magnetic appliance. Eur J Orthod. (2000) 22:683–95. 10.1093/ejo/22.6.683

11212604

120.

Zhu

. A comparison of treatment effectiveness between clear aligner and fixed appliance therapies. BMC Oral Health. (2019) 19(1):24. 10.1186/s12903-018-0695-z

30674307

121.

Ferguson

Carano

Bowman

Davis

Gutierrez Vega

Lee

. A comparison of two maxillary molar distalizing appliances with the distal jet. World J Orthod. (2005) 6:382–90.16379210

122.

Yazdi

Daryanavard

Ashtiani

Moradinejad

Rakhshan

. A systematic review of biocompatibility and safety of orthodontic clear aligners and transparent vacuum-formed thermoplastic retainers: bisphenol-A release, adverse effects, cytotoxicity, and estrogenic effects. Dent Res J (Isfahan). (2023) 20:41. 10.4103/1735-3327.372658

37180685

123.

Keser

Naini

. Accelerated orthodontic tooth movement: surgical techniques and the regional acceleratory phenomenon. Maxillofac Plast Reconstr Surg. (2022) 44:1. 10.1186/s40902-021-00331-5

34984554

124.

Lyu

Cao

Chen

Liu

Accumulated biomechanical effects of mandibular molar mesialization using clear aligners with auxiliary devices: an iterative finite element analysis. Prog Orthod. (2023) 24:13. 10.1186/s40510-023-00462-7

37032410

125.

Pasciuti E, Coloccia G, Inchingolo AD, Patano A, Ceci S, Bordea IR, et al. Applied Sciences | Free Full-Text | Deep Bite Treatment with Aligners: A New Protocol. Available online at:

https://www.mdpi.com/2076-3417/12/13/6709

(Accessed October 5, 2023).

126.

Inchingolo

Ceci

Patano

Inchingolo

Montenegro

Pede

Applied Sciences | Free Full-Text | Elastodontic Therapy of Hyperdivergent Class II Patients Using AMCOP® Devices: A Retrospective Study. Available online at:

https://www.mdpi.com/2076-3417/12/7/3259

(Accessed November 2, 2023).

127.

Malcangi

Inchingolo

Patano

Coloccia

Ceci

Garibaldi

Applied Sciences | Free Full-Text | Impacted Central Incisors in the Upper Jaw in an Adolescent Patient: Orthodontic-Surgical Treatment—A Case Report. Available online at:

https://www.mdpi.com/2076-3417/12/5/2657

(Accessed October 1, 2023).

128.

Kinzinger

GSM

Gross

Fritz

Diedrich

. Anchorage quality of deciduous molars versus premolars for molar distalization with a Pendulum appliance. Am J Orthod Dentofacial Orthop. (2005) 127:314–23. 10.1016/j.ajodo.2004.09.014

15775946

129.

Loberto

Paoloni

Pavoni

Cozza

Lione

. Anchorage loss evaluation during maxillary molars distalization performed by clear aligners: a retrospective study on 3D digital casts. Appl Sci. (2023) 13:3646. 10.3390/app13063646

130.

Urdiales-Gálvez

Martín-Sánchez

Maíz-Jiménez

Castellano-Miralla

Lionetti-Leone

. Concomitant use of hyaluronic acid and Laser in facial rejuvenation. Aesthetic Plast Surg. (2019) 43:1061–70. 10.1007/s00266-019-01393-7

131.

Vainio

. Connection between movements of mouth and hand: perspectives on development and evolution of speech. Neurosci Biobehav Rev. (2019) 100:211–23. 10.1016/j.neubiorev.2019.03.005

30871957

132.

Liew

WTL

Chan

WWS

Kim

H-J

Goodman

Consensus on changing trends, attitudes, and concepts of Asian beauty. Aesthetic Plast Surg. (2016) 40:193–201. 10.1007/s00266-015-0562-0

26408389

133.

Raggio

Brody-Camp

Jawad

Winters

Aslam

. Complications associated with medical tourism for facial rejuvenation: a systematic review. Aesthetic Plast Surg. (2020) 44:1058–65. 10.1007/s00266-020-01638-w

32040602

134.

Choi

S-H

Shi

K-K

Cha

J-Y

Park

Y-C

Lee

K-J

. Nonsurgical miniscrew-assisted rapid maxillary expansion results in acceptable stability in young adults. Angle Orthod. (2016) 86:713–20. 10.2319/101415-689.1

26938955

135.

Malcangi

Patano

Palmieri

Riccaldo

Pezzolla

Mancini

Oral piercing: a pretty risk—a scoping review of local and systemic complications of this current widespread fashion. Int J Environ Res Public Health. (2023) 20:5744. 10.3390/ijerph20095744

37174261

136.

Dinoi

Marchetti

Garagiola

Caruso

Mummolo

Marzo

. Orthodontic treatment of an unerupted mandibular canine tooth in a patient with mixed dentition: a case report. J Med Case Rep. (2016) 10:170. 10.1186/s13256-016-0923-6

27286815

137.

Gibson

Claus

Sanguinetti

Witkiewitz

Clark

. A review of functional brain differences predicting relapse in substance use disorder: actionable targets for new methods of noninvasive brain stimulation. Neurosci Biobehav Rev. (2022) 141:104821. 10.1016/j.neubiorev.2022.104821

35970417

138.

Bell

. A review of maxillary expansion in relation to rate of expansion and patient’s age. Am J Orthod. (1982) 81:32–7. 10.1016/0002-9416(82)90285-8

6758589

139.

Lo Russo

Caradonna

Salamini

Guida

. A single procedure for the registration of maxillo-mandibular relationships and alignment of intraoral scans of edentulous maxillary and mandibular arches. J Prosthodont Res. (2020) 64:55–9. 10.1016/j.jpor.2019.04.009

31101518

140.

Hadavi

Caffesse

Charbeneau

. A study of the gingival response to polished and unpolished amalgam restorations. J Can Dent Assoc. (1986) 52:211–4.3513918

141.

Adam

Mohd

Rani

Mohd Yusof

MYP

Baharin

. A systematic review and meta-analysis on the comparative effectiveness of Salvadora Persica—extract mouthwash with chlorhexidine gluconate in periodontal health. J Ethnopharmacol. (2023) 302:115863. 10.1016/j.jep.2022.115863

36283639

142.

Ogordi

Ize-Iyamu

. A ten year audit of traumatic dental injuries in children in a tertiary hospital in southern Nigeria. Niger J Dent Res. (2020) 5:177.

143.

Zhang

J-L

Peng

Z-L

Huang

Pan

Y-J

Sun

Z-W

Mai

Z-H

. A two-year retrospective study on traumatic dental injury in the primary dentition. Medicine (Baltimore). (2023) 102:e35750. 10.1097/MD.0000000000035750

37960738

144.

West

Ernst

Jansson-Hutson

Skerrett

. Activation of toll-like receptors by Burkholderia Pseudomallei. BMC Immunol. (2008) 9:46. 10.1186/1471-2172-9-46

18691413

145.

Boeckel

Sesterheim

Peres

Augustin

Wartchow

Machado

Adipogenic mesenchymal stem cells and hyaluronic acid as a cellular compound for bone tissue engineering. J Craniofac Surg. (2019) 30:777–83. 10.1097/SCS.0000000000005392

30865107

146.

Avila

Williams

Disselhorst-Klug

. Advances in EMG measurement techniques, analysis procedures, and the impact of muscle mechanics on future requirements for the methodology. J Biomech. (2023) 156:111687. 10.1016/j.jbiomech.2023.111687

37339541

147.

Kim

S-H

Kim

. Advances in maxillary transverse deficiency treatment. Semin Orthod. (2025) 31:177–8. 10.1053/j.sodo.2024.12.004

148.

Inchingolo

Patano

Coloccia

Ceci

Inchingolo

Marinelli

Treatment of class III malocclusion and anterior crossbite with aligners: a case report. Medicina. (2022) 58:603. 10.3390/medicina58050603

35630020

149.

Baccetti

Franchi

Cameron

McNamara

. Treatment timing for rapid maxillary expansion. Angle Orthod. (2001) 71:343–50. 10.1043/0003-3219(2001)071/3C0343:TTFRME/3E2.0.CO;2

11605867

150.

Peters

MDJ

Marnie

Tricco

Pollock

Munn

Alexander

Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. (2020) 18:2119–26. 10.11124/JBIES-20-00167

33038124

151.

Mummolo

Nota

Marchetti

Padricelli

Marzo

. The 3D tele motion tracking for the orthodontic facial analysis. Biomed Res Int. (2016) 2016:4932136. 10.1155/2016/4932136

28044130

152.

Merheb

Vercruyssen

Coucke

Beckers

Teughels

Quirynen

. The fate of buccal bone around dental implants. A 12-month postloading follow-up study. Clin Oral Implants Res. (2017) 28:103–8. 10.1111/clr.12767

26749417

153.

Lanteri

Beretta

Lanteri

Gianolio

Cherchi

Franchi

. The leaf expander for non-compliance treatment in the mixed dentition. J Clin Orthod. (2016) 50:552–60.27809214

154.

Page

McKenzie

Bossuyt

Boutron

Hoffmann

Mulrow

The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Br Med J. (2021) 372:n71. 10.1136/bmj.n71

155.

Quinzi

Ferro

Rizzo

Marranzini

Federici Canova

Mummolo

The two by four appliance: a nationwide cross-sectional survey. Eur J Paediatr Dent. (2018) 19(2):145–50. 10.23804/ejpd.2018.19.02.09

29790779

156.

Cossellu

Ugolini

Beretta

Farronato

Gianolio

Maspero

Three-Dimensional evaluation of slow maxillary expansion with leaf expander vs. Rapid maxillary expansion in a sample of growing patients: direct effects on maxillary arch and spontaneous mandibular response. Appl Sci. (2020) 10:4512. 10.3390/app10134512

157.

Tausche

Hansen

Hietschold

Lagravére

Harzer

. Three-Dimensional Evaluation of Surgically Assisted Implant Bone-Borne Rapid Maxillary Expansion: A Pilot Study—ScienceDirect. Available online at:

https://www.sciencedirect.com/science/article/pii/S0889540606015071?via/3Dihub

(Accessed June 27, 2023).

158.

Khosravi

Ugolini

Miresmaeili

Mirzaei

Shahidi-Zandi

Soheilifar

Tooth-Borne versus Bone-Borne Rapid Maxillary Expansion for Transverse Maxillary Deficiency: A Systematic Review—PubMed. Available online at:

https://pubmed.ncbi.nlm.nih.gov/31280998/

(Accessed June 26, 2023).

Glossary

AMCOP®

Armonizzatori Multifunzionali Cranio-Occluso-Posturali

Deltadent®

Digital Cephalometric Software

sEMG

Surface Electromyography

POC

Percentage of Overlapping Coefficient

Temporalis Anterior

Masseter Muscle

BAR

Barycenter Index

TORS

Torsion Index

IMP

Impact Index

ASIM

Asymmetry Index

Clenching Level

SENIAM

Surface Electromyography for the Non-Invasive Assessment of Muscles

ICC

Intraclass Correlation Coefficient

ANS

Anterior Nasal Spine

PNS

Posterior Nasal Spine

Sella

Nasion

Point A (Subspinale)

Point B (Supramentale)

Gonion

Gnathion

Menton

Pog

Pogonion

SNA (°)

Sella–Nasion–Point A angle

SNB (°)

Sella–Nasion–Point B angle

ANB (°)

Point A–Nasion–Point B angle

SN–GoGn (°)

Sella–Nasion to Gonion–Gnathion angle

PP–MP (°)

Palatal Plane to Mandibular Plane angle

ANS–Me (mm)

Anterior Nasal Spine to Menton

FMA (°)

Frankfort–Mandibular Plane Angle

U1–PP (°)

Upper incisor to Palatal Plane

L1–MP (°)

Lower incisor to Mandibular Plane

Upper Incisor Axis

Lower Incisor Axis

IS∧II (°)

Interincisal Angle

OVJ (mm)

Overjet

OVB (mm)

Overbite

Wits (mm)

Wits Appraisal

SN∧Ba (°)

Sella–Nasion to Basion angle

SNA–SNP∧Go–Gn (°)

Maxillo–Mandibular Angle

Go–Me (°)

Gonion–Menton angle

SND (°)

Sella–Nasion–D point angle

N–S∧CoP (°)

Nasion–Sella to Condylar Point

S–Co–Go (°)

Sella–Condylion–Gonion angle

Co–Go–Gn (°)

Condylion–Gonion–Gnathion angle

Go–Me–SN (°)

Gonion–Menton to Sella–Nasion

T0/T1

Time 0/Time 1

MVC

Maximum Voluntary Clench

Standard Deviation

Δ (Delta)

Change/Difference

α (Alpha)

Significance Level

Edited by: Sreekanth Kumar Mallineni, Dr Sulaiman Al Habib Hospital, Ar Rayyan, Saudi Arabia

Reviewed by: Sara Di Nicolantonio, University of L'Aquila, Italy

Domenico Ciavarella, University of Foggia, Italy