Malocclusion

The measurement properties of the CPQ_11–14-ISF-16; the CPQ_11–14-ISF-8; the CPQ_11–14-RSF-16 and the CPQ_11–14-RSF-8 were evaluated using the data from the validity and reliability studies for the long-form CPQ_11–14 [1 (link)]. Scores for all short forms were calculated by summing the response codes to their questions. Criterion validity, construct validity and internal consistency reliability were assessed based on the responses from 123 children. Clinical data were obtained for 26 of the paediatric dentistry group, 45 of the group with malocclusions and all 39 of the oro-facial group and used for further assessments of construct validity. Sixty-five of the 123 children, who completed the CPQ_11–14 again after a period of two weeks and who did not report change in either their oral health or its impact on their overall well-being at the follow-up, provided the data for the assessment of test-retest reliability.
For criterion validity, positive high correlations between the long-form and each short-form questionnaire were expected. For discriminant construct validity, the hypothesis that the scores are highest in the oro-facial, lower in the orthodontic and lowest in the paediatric dentistry group was tested. It was also hypothesized that within each of the three groups scores would be highest for those with the most severe clinical condition. For correlational construct validity, positive correlations between the scores and children's global ratings of oral health and well-being were tested. Since the former is a measure of health and the latter a measure of health-related quality of life, it was predicted that the correlation coefficient would be higher for the rating of well-being than for the rating of oral health.
Relative validity (RV) estimates were computed as the ratios of F statistics for the short-form questionnaires and the original CPQ_11–14. They indicate in proportional terms how much more or less precise a short-form questionnaire is in relation to the original CPQ_11–14 [16 (link),17 (link)].
Internal consistency reliability was determined determined using Cronbach's alpha. Alphas were also calculated with each item deleted. Corrected item total correlations were also compared. Test-retest reliability was assessed using the intraclass correlation coefficient (ICC). This was calculated using a one-way analysis of variance random effects parallel model [18 (link),19 (link)].

Discriminative ability was examined in terms of construct validity whereby the distributions of scores for both OHRQoL measures are compared between groups with different levels of oral health [18 ]. Since overall scores for OHIP-14 and CS-OIDP attributed to malocclusion were not normally distributed (Shapiro-Wilks test, p < 0.001 in all cases), Mann-Whitney tests were used to compare both overall scores between adolescents with and without normative need for orthodontic treatment. To aid comparison and interpretation, the magnitude of differences was also expressed as an effect size [35 ,36 (link)], which was calculated as the mean difference between groups divided by the pooled standard deviation. The widely accepted thresholds of 0.2, 0.5 and 0.8 were used to define 'small', 'moderate' and 'large' effect sizes [35 ].
As the aforementioned method did not allow adjusting for covariates (sex, age, ethnicity and orthodontic treatment status), the prevalence of oral impacts was also compared between adolescents with and without normative need for orthodontic treatment. For that, the prevalence of oral impacts was calculated as the percentage of adolescents reporting one or more items 'fairly often' or 'very often' for OHIP-14 [23 (link)] and as the percentage of adolescents with a score higher than zero for CS-OIDP attributed to malocclusion [10 (link)]. Then, the prevalence of oral impacts was compared between adolescents with and with normative need using Poisson regression with robust estimation of variance while adjusting for covariates [37 (link),38 (link)].

M3 positional traits and eruption space measurements were recorded on CBCT derived panoramic radiographs. According to Pell &Gregory classification (Depth: PG-A, PG-B, PG-C; Ramus Relationship: PG-I, PG-II, PG-III) (Fig. 6) [16 (link), 17 (link)] and the angles of WP-based reference frame to classify M3s (A angle: [A1: < 27°, A2:27 ~ 67°, A3: > 67°]; B angle: [B1: < 14°, B2:14 ~ 24°, B3: > 24°]). WP-based reference system is the main reference system in this study, and OP-based reference system was used as an auxiliary system. M3s were classified according to the A and B angles of the former. We divided the A angle and B angle into the three classifications according to the trisection of a sample size to ensure the comparability between samples, individually. Additionally, all M3s also were grouped according to the patient's age, sex, and Angle malocclusion classification, respectively. Group 1 was for male, Group 2 was for female, Group 3 was for class I malocclusion, Group 4 was for class III malocclusion, Group 5 was for 18–27 years old and Group 6 was for 28–40 years old.Fig. 6

The classification criterion of Pell&Gregory. A Depth of Pell&Gregory Classification. PG-A: The highest part of the M3 was on the same level or higher than the occlusion plane of the second molar. PG-B: The highest part of the M3 is below the occlusal plane of the second molar, but higher than the neck of the second molar. PG-C: The highest position of the M3 is below the neck of the second molar. B Ramus relationship of Pell&Gregory Classification. PG-I: Sufficient space available between the anterior border of the ascending ramus and distal side of second molar to accommodate mesiodistal width of the crown of the M3. PG-II: The space available between the anterior border of the ramus and the distal side of the second molar is less than the mesiodistal width of the crown of the M3. PG-III: All or most of the M3 is embedded in the mandibular ramus

Randomized samples of saliva and GCF were taken from the First Dental Clinic, Faculty of Medicine, University of Pavel Jozef Šafárik in Košice, and in the Academy of Košice n.o., in the period from May 1 to 31, 2022. A total sample size (N = 45) was calculated using G*Power software (version 3.1.9.7, Düsseldorf, Germany), i.e., using Analysis of Variance (ANOVA) (fixed effect, omnibus, and one way) test; the effect size (f = 0.48), number of groups (N = 3) at the 5% significance level (α = 0.05), and statistical power (1 − β) = 0.8 were measured. A total of 45 samples of gingival fluids and 45 samples of saliva were obtained from the same patients. Of these, 15 control samples (GCF and saliva) were obtained from healthy donors with a mean age of 24.0 years (range: 22–26 years), 15 patients with FOA (GCF and saliva) with a mean age of 21.3 years (14–39 years), and 15 patients with the Invisalign system (GCF and saliva) with an average age of 22.7 years (13–36 years). To avoid the bias due to treatment, patients having clinical presentations which are the same (mild malocclusion between 2.1 and 4.0 mm) were included in the study. Lingual metallic brackets (Ormco Corporation, Glendora, CA, USA) were used for bonding in fifteen patients using orthodontic light-cured adhesive (Transbond XT). The 0.014-inch copper nickel titanium archwires (Tanzo, American Orthodontics, Sheboygan, WI, USA) were used. Fifteen other patients were undergoing treatment with Invisalign aligners (Align Technology, San Jose, CA, USA). The following patient inclusion criteria were applied: FOA or Invisalign^® for at least six months; modified sulcus bleeding index (SBI) ≤15% prior to orthodontic treatment, approximal plaque index (API) ≤ 25% prior to orthodontic treatment; declaration of consent. All patients (FOA and IN) received treatment in the upper jaw. Exclusion criteria were history of periodontitis, diseases that affect periodontal health, smoking, pregnancy, withdrawal of consent, and participation in another clinical trial.

The patients with metabolic bone disorders, thyroid problems, disorders of adrenal glands, systemic diseases, cirrhosis, chronic renal failures, gonadal pathology, vitamin D, parathormone and calcium metabolism disorders, patients with a previous or present use of medications effective on bone tissue, and patients with skeletal Class II or III malocclusions were excluded from the study. In OPGs in which the mental foramen and the regions of interest (ROIs) for fractal analysis cannot be clearly observed were also excepted.