Comparing Skeletal and Dentoalveolar Effects of Fixed Palatal Crib and Bonded Spurs in Early Management of Anterior Open Bite Associated with Non-Nutritive Sucking Habits: A Randomised Clinical Trial

Comparing Skeletal and Dentoalveolar Effects of Fixed Palatal Crib and Bonded Spurs in Early Management of Anterior Open Bite Associated with Non-Nutritive Sucking Habits: A Randomised Clinical Trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparing Skeletal and Dentoalveolar Effects of Fixed Palatal Crib and Bonded Spurs in Early Management of Anterior Open Bite Associated with Non-Nutritive Sucking Habits: A Randomised Clinical Trial Reem Shams, Mai Ali, Nihal Kabel, Ahmed Elkhadem This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6660641/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Purpose To assess how fixed palatal cribs and bonded spurs affect skeletal and dentoalveolar parameters during the management of anterior open bite induced by non-nutritive sucking habits Methods This study was a randomised clinical trial involving 30 patients ranging from 6 to 11 years with anterior open bite ≥ 1 mm, randomly allocated into two groups: fixed palatal crib (FPC, n = 15, mean age 8.6 years) and bonded spurs (BS, n = 15, mean age 8.3 years). Digital biomodels and lateral cephalometric images were obtained at the beginning of the trial and 12 months post-treatment to assess the changes. Paired and independent t-tests were used for intra- and intergroup comparisons, respectively. Results Intergroup analysis showed the FPC group achieved significantly greater overbite correction than the BS group (1.22 ± 2.18 mm, p = 0.00387), with 73.33% achieving a positive overbite compared to 6.67% in the BS group. The FPC group also showed significantly higher increases in mandibular arch perimeter (2.57 ± 0.79 mm, p = 0.00314), maxillary arch length (1.56 ± 0.35 mm, p = 0.00013), mandibular arch length (1.62 ± 0.30 mm, p = 0.00001), and intermolar width (0.71 ± 0.24 mm, p = 0.00001). Cephalometric findings showed greater reduction in the lower central incisor mandibular plane angle (6.75 ± 1.65°, p = 0.00032) and a corresponding increase in the interincisal angle (6.12 ± 2.61°, p = 0. 02654), while skeletal measurements showed no statistically relevant variation between the two groups. Conclusion The fixed palatal crib appliance was more effective than bonded spurs in managing anterior open bite in growing patients, mainly via dentoalveolar changes like incisor retroclination, without affecting skeletal parameters. Trial registration This trial was registered at clinical trial.gov, ID NCT05313399. Fixed palatal crib bonded spurs Anterior open bite Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Anterior open bite (AOB) refers to a type of malocclusion characterised by a lack of vertical overlap between the upper and lower incisors, despite the posterior teeth maintaining occlusal contact ( Tavares and Allgayer 2019 ) .​ It can be result from a combination of skeletal factors, such as excessive vertical facial growth, and environmental influences, including prolonged non-nutritive sucking habits and tongue-thrusting ( Ngan and Fields 1997 ) . In Egypt, AOB prevalence ranges between 1.6% and 20.9%, depending on age and gender ( ElMotaleb et al. 2014 ; Fsifis et al. 2016 ; El-Sayed and Abdel Ghani 2019 ) . The severity of AOB is classified according to the vertical separation between the upper and lower incisors: moderate (0–2 mm), severe (3–4 mm), and extreme when exceeding 4 mm (Proffit WR, Fields HW 2007) . Anterior open bite is associated with a significantly increased risk of speech articulation errors, occurring 12 to 50 times more frequently than in individuals with normal occlusion, alongside a marked reduction in mastication efficiency by approximately 60–72%, ( Tavares and Allgayer 2019 ) . Relapse after correction is also common roughly 10–30% of treated cases tend to reopen over time ( González Espinosa et al. 2020 ) ​ . Treatment approaches for AOB are generally categorised into three strategies: eliminating the aetiological habit (if present), correcting dental malocclusion, or addressing skeletal discrepancies through orthopaedic or surgical means, depending on the underlying cause and severity ( Wang et al. 2024 ). In early-diagnosed habit-related AOB, non-appliance methods such as behaviour modification and positive reinforcement are often first ( Davidson 2008 ; Borrie et al. 2015 ). if non-appliance therapy fails to eliminate the habit, the use of habit-breaking appliances such as palatal cribs or spurs is advised to facilitate bite closure and correct the positioning of the tongue ( Huang et al. 1990 ; Justus 2001 ) . Fixed palatal crib was first introduced in the 1950s ( Massler and Chopra 1950 ) facilitating spontaneous bite closure and allowing normal incisor eruption (Berger and Janisse 2013; Leite et al. 2016 ). However, their use has been associated with challenges such as speech difficulties, oral hygiene complications, and tongue disco0mfort (Iqbal MDK., Bhat M., Antony T. 2019) . Bonded spurs were introduced in 2005 as a less intrusive alternative, designed to be attached to the lingual or palatal surfaces of incisors ( Nogueira et al. 2005 ). They guide tongue posture through proprioceptive feedback, modifying tongue function without obstructing the oral space ( Justus 2001 ) . A systematic review by ( Koletsi et al. 2018 ) emphasised the absence of robust evidence regarding early orthodontic interventions for AOB, and concluded that no evidence supported the superiority of bonded spurs over fixed banded appliances. Similarly, ( Meng et al. 2022 ) reported that only two studies had directly compared fixed palatal cribs and bonded spurs, with limited and inconsistent evidence regarding their long-term outcomes and potential adverse effects, and inconclusive findings. Given these limitations, this trial aims to comprehensively examine the impact of fixed palatal cribs and bonded spurs on both skeletal and dentoalveolar structures, addressing gaps in previous research by incorporating a detailed analysis of arch dimensions and vertical skeletal changes in children with AOB due to non-nutritive sucking habits (NNSHs). Materials and methods The randomised clinical trial with parallel groups was conducted at the Outpatient Diagnostic Clinic, Department of Paediatric Dentistry and Dental Public Health, Faculty of Dentistry, Cairo University, from September 2022 to May 2023. Approval for the study’s ethical conduct was secured from the Research Ethics Committee of the Faculty of Dentistry, Cairo University, with clearance granted on 28/06/2022. The trial protocol was registered prospectively registered at ClinicalTrials.gov (Identifier: NCT05313399). Sample Size Calculation: Sample size determination was conducted through a power analysis targeting the detection of differences in AOB correction between the fixed palatal crib (FPC) and bonded spurs (BS) groups. Based on a previous trial by ( Leite et al. 2016 ), the analysis incorporated an alpha level of 0.05, 80% statistical power, and an effect size of 1.23 (Cohen’s d ), derived from changes in overbite correction.. The smallest required sample size was calculated to be 24 participants. An additional 25% was added to the sample size, resulting in a final sample of 30 children, with 15 randomly assigned to each group to account for potential dropouts. Sample size estimation was performed using G*Power )version 3.1.9.7) ( Faul et al. 2007 ). Inclusion criteria: Eligible participants were children aged 6 to 11 years AOB ≥ 1 mm associated with NNSHs, and tongue thrust were considered eligible. Only participants with fully erupted permanent upper and lower central incisors and a clinically confirmed Angle Class I molar relationship were included. Exclusion Criteria: Children exhibited craniofacial anomalies, developmental or systemic disorders, a history of orthodontic treatment, or previous extraction of permanent teeth due to trauma or caries. Subject Recruitment: Recruitment was conducted between September 2022 and May 2023. A total of 50 participants were initially screened for eligibility, 20 did not meet the predefined inclusion criteria and were therefore excluded. The remaining 30 eligible participants were randomly allocated into two groups: the fixed palatal crib (FPC) group and the bonded spurs (BS) group, with 15 children in each. The randomisation sequence was generated by M.M.A using www.random.org , and sealed opaque envelopes were prepared for allocation concealment, and R.H conducted group assignments, recorded participant details, and managed follow-up coordination. The randomisation protocol and overall study design were developed and approved by A.H, who ensured proper methodological planning and compliance. Follow-up was completed by May 2024 following the scheduled course of treatment. Participant flow is illustrated in the CONSORT flow chart ( Fig. 1 ) . All 30 participants completed the one-year follow-up, with no dropouts. Clinical Examination: Before treatment, all participants underwent comprehensive clinical documentation, including intraoral and extraoral photographs, panoramic radiographs, digital lateral cephalometric radiographs, and digital biomodels were generated by scanning stone dental casts using the Medit i500 scanner (Medit Corp., Seoul, South Korea), which produced stereolithographic (STL) files for analysis The clinical assessment included evaluation of anterior open bite, molar relationship, tongue thrust, and oral habits. Additionally, a preparatory behavioural phase was implemented, during which each child received oral hygiene instructions and caries control. Blinding: Blinding was implemented for the outcome assessors; however, it was not feasible for the operator or patients due to the visible nature of the interventions. Interventions: Bonded spurs (Tongue Tamers®, Ortho Technology, Tampa FL) were placed on the palatal surfaces of the maxillary incisors and the lingual surfaces of the mandibular incisors, positioned at the cervical and incisal thirds respectively, to reduce potential occlusal interference. Attachment of the spurs was achieved using Transbond™ XT (3M Unitek, St. Paul, MN, USA), a light-cured orthodontic adhesive after acid etching to ensure optimal retention ( Justus 2001 ; Leite et al. 2016 ; Aliaga-Del Castillo et al. 2021 ). The FPC was fabricated by adapting bands (Ormco Corporation, Glendora, CA, USA) with a 0.9 mm wire loop soldered to extend between the maxillary canines. Orthodontic separators were placed to ensure a proper fit before cementation. Glass ionomer cement (Medicem glass ionomer, Promedica Dental Material GmbH, Germany) was used for secure attachment ( Leite et al. 2016 ). Participants who failed to show adequate improvement in AOB or required additional management were referred for fixed appliance therapy to ensure appropriate clinical care. Outcome Measures: The primary outcome of this trial was overbite correction, measured in millimeters using digital bio models derived from intraoral scans of dental casts. A secondary outcome was the achievement of a positive overbite (i.e., incisal overlap), regarded in previous studies ( Slaviero et al. 2017 ; Aliaga-Del Castillo et al. 2021 ) as a reliable clinical indicator of successful AOB correction. Secondary outcomes also included changes in arch dimensions, which were evaluated via digital biomodels, and vertical skeletal changes were assessed through lateral cephalograms. Digital biomodels were analysed using OrthoAnalyzer 3D software (3Shape, Copenhagen, Denmark) to quantify changes in overbite, arch length, arch perimeter, vertical development and intermolar distance ( Fig. 2 ) . Lateral cephalometric analysis was performed using Dolphin Imaging Software Version 11.5 (Dolphin® Imaging and Management Solutions, Patterson Dental Supply, Inc., Chatsworth, CA) was assessed skeletal and dentoalveolar changes by evaluating the maxillary-mandibular plane angle (MMPA) along with other dentoalveolar parameters (Fig. 3 ). The detailed description of all measured variables is provided in ( Table 1 ( . Digital biomodels and cephalometric measurements were primarily conducted by R.H and independently verified by A.H, both trained and calibrated in the use of the respective software tools. Table 1 Linear measurements on digital models. Measurement Type Variables Definition Digital Cast Measurements Dental relationship, mm Overbite The vertical overlap is measured from the incisal edge of the upper central incisor to the corresponding surface of the lower incisor. Overjet The horizontal gap between the labial surface of the upper incisor and that of the lower incisor, assessed in a parallel plane to the occlusal surface. (U6-rugae) Distance from the mesial surface of the upper first molar (U6) to a line intersecting the right and left third palatal rugae. Vertical development, mm Mx and Md anterior dentoalveolar vertical development The vertical measurement represents the perpendicular span from the alveolar ridge at the contact point (or midpoint in cases of spacing) between the central incisors, extending occlusally in a frontal projection. The occlusal reference plane was determined by connecting the mesiobuccal cusps of the permanent first molars with the cusp tips of either the deciduous first molars or the first premolars on each side of the maxilla and mandible. Arch dimensions, mm Arch perimeter The total arch length is determined by summing four linear segments starting at the mesial surface of the permanent first molars, extending through the deciduous canines to the central incisors on each side. Arch length The shortest linear distance drawn perpendicularly from a horizontal line connecting the mesial aspects of the first molars to the point of contact, or midpoint, between the central incisors at the gingival margin. 6–6 The linear distance between the first permanent molars measured at the midpoint of the palatal or lingual gingival margin. Lateral Cephalometric Measurements Dental relationship 1.1 This angle is measured at the point where the long axes of the upper and lower central incisors intersect. Maxillomandibular relationship ANB (˚) Calculated by subtracting the SNB angle from the SNA angle, this measurement indicates the anteroposterior positional relationship between the maxilla and mandible. Vertical components Y-axis (˚) The line connecting Sella to Gnathion is an estimate of the direction of mandibular growth. LAFH (mm) Represents the vertical facial height measured between the anterior nasal spine (ANS) and menton (Me), indicating the vertical dimension of the lower facial third. MMPA The angular relationship between the palatal plane (spanning from ANS to PNS) and the mandibular plane (from Gonion to Menton), reflecting the vertical skeletal pattern. Maxillary and Mandibular dentoalveolar components Mx1.PP (˚) This is the angular relationship between the upper incisor’s axis and the palatal plane, which reflects the degree of maxillary incisor inclination. IMPA (˚) The angular distance between the axis of the lower central incisor and the mandibular plane, indicating the extent of incisor proclination or retroclination. [1] U6-rugae: Antero-posterior position of the upper first molar, Mx Ver: Maxillary vertical development, Md Ver Mandibular vertical development,6-6: Inter first permanent molars width, 1.1: interincisal angle, ANB: A point–Nasion–B point angle, LAFH: Lower Anterior Facial Height, MMPA: Maxillary-mandibular plane angle, Mx1 . PP: Maxillary central incisor to palatal plane angle and IMPA: Mandibular central incisor to mandibular plane angle. Data processing and analysis: Statistical evaluation was conducted using SPSS® software (version 20, IBM Corp., Armonk, NY, USA). Data normality was verified through the Kolmogorov–Smirnov and Shapiro–Wilk tests, confirming the suitability for parametric analysis. The paired t-test was applied to compare pre-and post-treatment values within each group, while intergroup differences were analysed using the independent t-test. A significance level was set at p < 0. 05. To compare categorical variables, such as treatment success (i.e., positive overbite), the chi-square test was utilised. Relative risk (RR) and the corresponding 95% confidence intervals were also computed and reported. To verify intra- and inter-observer reliability, measurements from 10% of the digital biomodels and lateral cephalograms were re-evaluated by the same independent observer one month after initial analysis. Intraclass correlation coefficients (ICCs) were calculated, yielding values of 0.93 for intra-observer and 0.91 for inter-observer reliability, indicating excellent agreement. No modifications were made to the trial outcomes after the study commenced. Results Baseline Data: Demographic characteristics such as age and gender for both groups are presented in (Table 2) . Numbers Analysed: Twelve months post-treatment, digital biomodel evaluation revealed notable alterations within the FPC group. Overbite increased significantly by 3.11 ± 0. mm ( Fig. 4 ) , with a mesial movement of the upper first molars (1.22 ± 0.83 mm). Additionally, arch dimensions were reduced, with mandibular arch perimeter (MdAP), maxillary arch length (MxAL), mandibular arch length (MdAL) and maxillary intermolar width distance (Mx6-6) decreasing by 2.46 ± 1.51 mm, 1.43 ± 1.22 mm, 1.27 ± 1.27 mm, and 0.55 ± 0.62 mm, respectively ( Table 3 ) . These dentoalveolar modifications, identified through digital biomodels as changes in tooth position and alveolar bone without skeletal base involvement, contributed to a significantly higher proportion of patients achieving a positive overbite in the FPC group (73.33%) compared to the BS group (6.67%), indicating that patients treated with FPC were 11 times more likely to achieve overbite correction, with a relative risk of 11.0 (95% CI: 1.62–74.88). In contrast, the BS group exhibited a significant increase in overbite by 1.89 ± 1.00 mm ( Fig. 5 ) , while maxillary vertical development showed a significant decrease by 0.98 ± 1.04 mm ( Table 4 ) . Table 2 : The baseline demographic data, including age and gender, for each group. Table 3 Pre- and post-treatment means, standard deviations) SD), and the outcomes of paired t-tests assessing the treatment-related differences in the FPC group. Measurement Type Variables Pre-treatment Post-treatment Change 95%CI for the change p - Value Mean SD Mean SD Mean SD Lower Bound Upper bound Digital Cast Measurements Dental Relationship Overbite (mm) -2.41 1.99 0.71 1.88 3.11 0.93 2.78 3.44 0.00155** Overjet (mm) 2.67 1.69 2.82 1.91 0.15 1.36 -0.60 0.91 0.34021 U6-rugae (mm) 11.3 2.33 10.11 2.43 -1.22 0.83 -1.68 -0.76 0.01998* Vertical Development Mx Ver (mm) 7.61 1.92 6.57 1.32 -1.04 2.10 -2.20 0.12 0.07553 Md Ver (mm) 3.66 1.98 3.37 1.71 -0.28 0.93 -0.80 0.23 0.25359 Arch Dimension MxAp 74.88 3.09 75.49 6.83 0.61 7.11 -3.33 4.55 0.74382 MdAP 69.16 3.29 66.70 3.59 -2.46 1.51 -3.29 -1.62 0.00002*** MxAL 27.23 1.32 25.80 1.86 -1.43 1.22 -2.10 -0.75 0.00046*** MdAL 23.27 1.57 22.00 1.75 -1.27 -1.27 -1.64 -0.90 0.00000*** Mx6-6 34.60 2.70 34.04 2.66 -0.55 0.62 -0.90 -0.21 0.00392** Md6-6 32.62 1.80 32.66 1.74 0.04 0.47 -0.22 0.30 0.76674 Lateral Cephalometric Measurements Dental Relationship 1.1(˚) 109.38 10.10 115.77 10.37 6.39 6.77 2.64 10.14 0.00260** Maxillomandibular relationship ANB (˚) 5.99 2.43 6.13 2.21 0.13 1.10 -0.48 0.74 0.64610 Vertical components Y-axis (˚) 70.39 3.14 69.51 3.76 -0.88 2.33 -2.17 0.41 0.64610 MMPA (˚) 30.57 3.69 30.99 3.13 0.42 2.68 -1.06 1.90 0.55299 LAFH (mm) 60.41 4.37 61.47 3.94 1.07 4.10 -1.20 3.34 0.33068 Dentoalveolar Measurements Mx1.PP (˚) 119.73 5.49 120.10 5.66 0.37 5.00 -2.39 3.14 0.77647 IMPA (˚) 100.27 6.22 93.14 6.22 -7.13 4.86 -9.83 -4.44 0.00006*** p -values interpretation: * p ≤ 0.05: significant; ** p ≤ 0.01: highly significant; *** p ≤ 0.001: very highly significant; ns: non-significant ( p > 0.05). CI: confidence interval Lateral cephalometric analysis confirmed significant dentoalveolar changes in both groups. In the FPC group, a significant reduction in incisor mandibular plane angle (IMPA) by 7.13 ± 4.86° was observed, accompanied by an increase in the interincisal angle (1.1) by 6.39 ± 6.77°, reflecting significant incisor inclination changes ( Table 3 ) . In the BS group, no cephalometric variables showed statistically significant changes ( Table 4 ) . Comparative analysis ( Table 5 ) revealed that the FPC group achieved greater improvements in overbite correction compared to the BS group, with a mean difference of 1.22 ± 2.18 mm. Additionally, IMPA reduction was significantly greater in the FPC group by 6.75 ± 1.65°, indicating a more pronounced effect on incisor inclination and overall dentoalveolar changes. The FPC group also demonstrated a significantly greater increase in the interincisal angle (6.12 ± 2.61°) compared to the BS group. Regarding arch dimensional changes, the FPC group exhibited significantly greater reductions, with MdAP decreasing by 2.57 ± 0.79 mm, MxAL by 1.56 ± 0.35 mm, and MdAL by 1.62 ± 0.30 mm. Additionally, the Mx6-6 was reduced by 0.71 ± 0.24 mm. However, skeletal parameters, including MMPA, exhibited no statistically significant differences found between groups, with a minimal mean change of 1.56 ± 1.22°, indicating no significant alterations in vertical skeletal relationships across treatment modalities. Table 4 Pre- and post-treatment means, standard deviations (SD), and the outcomes of paired t-tests assessing the treatment-related differences in the BS group. Measurement Type Variables Pre-treatment Post-treatment Change 95%CI for the change p - Value Mean SD Mean SD Mean SD Lower Bound Upper bound Digital Cast Measurements Dental Relationship Overbite (mm) -3.57 1.68 -1.68 1.89 1.89 1.00 1.53 2.25 0.00000*** Overjet (mm) 2.40 1.89 2.55 1.45 0.15 0.88 -0.34 0.64 0.81086 U6-rugae (mm) 11.47 2.05 11.27 1.95 -0.21 1.06 -0.80 0.38 0.78825 Vertical Development Mx Ver (mm) 7.80 1.50 6.82 2.16 -0.98 1.04 0.27 -1.56 0.00254** Md Ver (mm) 4.52 1.28 4.24 1.26 -0.27 1.34 -1.02 0.47 0.44328 Arch Dimension MxAp 76.55 3.49 76.40 3.62 -0.15 1.27 -0.86 0.55 0.44328 MdAP 69.16 3.89 69.27 3.47 0.11 2.68 -1.38 1.59 0.87747 MxAL 27.64 1.79 27.77 1.60 0.13 0.60 -0.20 0.46 0.42043 MdAL 23.13 1.79 23.48 1.82 0.35 0.96 -0.18 0.88 0.17724 Mx6-6 34.64 2.58 34.79 2.52 0.16 0.70 -0.23 0.55 0.39676 Md6-6 32.33 2.24 32.33 2.41 0.00 0.66 -0.36 0.36 0.99691 Lateral Cephalometric Measurements Dental Relationship 1.1(˚) 112.21 9.35 112.48 8.89 0.27 7.52 -3.89 4.44 0.89008 Maxillomandibular relationship ANB (˚) 6.03 1.77 5.75 2.60 -0.28 1.29 -0.99 0.43 0.41474 Vertical components Y-axis (˚) 71.04 2.88 71.35 2.20 0.31 1.55 -0.54 1.17 0.44580 MMPA (˚) 33.51 3.59 32.37 4.50 -1.14 3.89 -3.29 1.01 0.27522 LAFH (mm) 61.82 4.47 61.56 3.78 -0.26 3.52 -2.21 1.69 0.77917 Dentoalveolar Measurements Mx1.PP (˚) 117.28 6.15 118.64 5.69 1.36 8.06 -3.11 5.83 0.52424 IMPA (˚) 97.00 5.42 96.62 6.15 -0.38 4.13 -2.67 1.91 0.52424 p -values interpretation: * p ≤ 0.05: significant; ** p ≤ 0.01: highly significant; *** p ≤ 0.001: very highly significant; ns: non-significant ( p > 0.05). CI: confidence interval Table 5 Mean values, standard deviations (SD), and outcomes of independent t-tests comparing changes across the two groups. Measurement Type Variables FPC -BS 95%CI for the change p - Value Mean SD Lower Bound Upper bound Digital Cast Measurements Dental Relationship Overbite (mm) 1.22 2.18 0.44 2.00 0.00387** Overjet (mm) 0.01 0.42 -0.85 0.87 0.92783 U6-rugae (mm) -1.01 1.23 -1.69 -0.34 0.01097* Vertical Development Mx Ver (mm) -0.06 0.60 -1.29 1.18 0.99691 Md Ver (mm) -0.01 0.42 -0.87 0.85 0.99691 Arch Dimension MxAp 0.76 1.87 -3.06 4.58 0.68547 MdAP -2.57 0.79 -4.19 -0.94 0.00314** MxAL -1.56 0.35 -2.27 -0.84 0.00013*** MdAL -1.62 0.30 -2.24 -1.00 0.00001*** Mx6-6 -0.71 0.24 -1.21 -0.22 0.00652** Md6-6 0.04 0.21 -0.39 0.46 0.85891 Dental Relationship 1.1(˚) 6.12 2.61 0.77 11.47 0.02654* Lateral Cephalometric Measurements Maxillomandibular relationship ANB (˚) 0.41 0.44 -0.48 1.31 0.35323 Vertical components Y-axis (˚) -1.19 0.72 -2.67 0.29 0.10996 MMPA (˚) 1.56 1.22 -0.94 4.06 0.21103 LAFH (mm) 1.33 1.40 -1.53 4.19 0.21103 Dentoalveolar Measurements Mx1.PP (˚) -0.99 2.45 -6.00 4.03 0.69013 IMPA (˚) -6.75 1.65 -10.13 -3.38 0.00032*** p -values interpretation: * p ≤ 0.05: significant; ** p ≤ 0.01: highly significant; *** p ≤ 0.001: very highly significant; ns: non-significant ( p > 0.05). CI: confidence interval Harms: The complications in the FPC group included some patients feeling discomfort due to the embedding of the appliance into the soft palate tissue, which led to pain and injury in that tissue. In the BS group, debonding was reported in 86.67% of patients, with an average of 0.87 debonding events per patient throughout the trial period. Some spurs were swallowed during meals, raising concerns among patients. Additionally, plaque accumulation around the spurs was observed despite oral hygiene instructions. Discussion Prolonged NNSHs can lead to dentomaxillofacial abnormalities like an AOB ( Artese et al. 2011 ). Early intervention is crucial to intercept and correct these habits, preventing further dental arch and occlusal deviations while preventing the progression of AOB ( Otaren et al. 2021 ). Habit-breaking appliances like lingual spurs and palatal cribs act as effective intraoral reminders to discourage the habit ( Khayami et al. 2013 ; Reddy and Dawjee 2019 ) . A systematic review ( Meng et al. 2022 ) identified only four studies evaluating the effects of FPC and BS in managing AOB, with just two directly comparing these appliances. Most existing research has focused primarily on overbite correction, while changes in arch dimensions and vertical skeletal changes remain insufficiently investigated. Given these gaps, this trial provides a comprehensive evaluation of the skeletal and dentoalveolar impacts of FPC and BS, offering clinicians evidence-based guidance for selecting the most effective approach in early AOB intervention. The statistical analysis showed that while both FPC and BS groups had significant overbite improvements, the FPC group was significantly more effective, allowing the rejection of the null hypothesis. This trial considered the achievement of a positive overbite as a clinically acceptable indicator of successful AOB correction. Although the FPC group showed superior success compared to the BS group, the overall percentages were lower than those reported by ( Leite et al. 2016 ), who documented a 100% success rate with FPC and 53.8% with BS. ( Rossato et al. 2018 ) also reported modest success across appliance types, suggesting that differences in appliance design, and follow-up periods may account for these variations. The effectiveness of FPC can be attributed to its design, which blocks tongue projection and disrupts harmful oral habits. In contrast, the failure in the BS group may be due to the absence of a sharpening procedure for the spurs, as recommended by ( Justus 2001 ) . This procedure was not implemented due to the absence of standardised guidelines and concerns over potential tongue injury. As a result, we think patients gradually adapted to the spurs, reducing their effectiveness over time as the tongue gets accustomed to the spurs. Thus, the secondary tongue thrusting would not be resolved over time with BS. Furthermore, the high debonding rate of BS (86.67%) in our sample introduced practical challenges, as frequent appliance detachment likely contributed to lower patient compliance and compromised treatment stability. Previous studies have reported overbite improvements of 3.95 mm for FPC and 3.07 mm for BS ( Leite et al. 2016 ), as well as 3.60 mm for FPC and 3.09 mm for BS ( Rossato et al. 2018 ), indicating a generally comparable performance between both appliances in AOB correction. However, some studies have reported greater improvements with BS (4.26 mm and 4.38 mm) (Canuto et al. 2016; Aliaga-Del Castillo et al. 2021 ), suggesting that clinical conditions may influence its effectiveness. Although bonded spurs produced a statistically significant improvement in overbite, the degree of correction observed in this trial was notably lower than previously reported values. Its intermittent mode of action may explain this, as BS relies mainly on proprioceptive feedback rather than physical interference, unlike FPC, which provides continuous mechanical interference against tongue thrusting. Previous studies (Canuto et al. 2016; Leite et al. 2016 ; Rossato et al. 2018 ) reported no significant changes in skeletal variables, aligning with the findings of this study. This pattern aligns with previous studies reporting minimal skeletal effects, indicating that the observed changes may be related more to dentoalveolar adaptations than to skeletal alterations. However, ( Mousa et al. 2021 ) observed a significant reduction in MMPA by 6.69° involving the use of a tongue crib in combination with a removable posterior bite plane, emphasising how treatment approaches and appliance types may impact skeletal modifications. The FPC group showed a significantly greater reduction in IMPA, reinforcing previous findings of 5.51° ( Leite et al. 2016 ) and 5.52° ( Rossato et al. 2018 ) but demonstrating an even more substantial effect in this trial. This notable retroclination of the mandibular incisors can be attributed to unopposed pressure from the lower lip during swallowing, a mechanism reinforced by the crib appliance’s design, which restricts tongue thrusting and promotes incisor repositioning. The BS group, however, showed minimal IMPA changes, even lower than past studies; 1.93° ( Leite et al. 2016 ) and 0.91° ( Rossato et al. 2018 ), reinforcing concerns about its limited ability to control incisor inclination. This reduction in the FPC group contributed to an increase in the interincisal angle, aligning with prior reports of 9.65° ( Rossato et al. 2018 ), reflecting its role in improving dental alignment. In contrast, the BS group failed to demonstrate meaningful interincisal angle changes, contrary to earlier reports of 3.34° ( Leite et al. 2016 ), suggesting greater variability in its clinical performance than previously assumed. Mesial displacement of the upper first molars was also noted in the FPC group, likely resulting from sustained tongue pressure exerted behind the appliance loops. This pressure-induced shift aligns with previous findings by ( Fouda et al. 2022 ) and reinforces the influence of tongue posture on dental arch adaptations. Additionally, reductions in MdAP, MxAL, and MdAL align with previous findings linking these changes to molar repositioning and lower incisor retroclination (Fouda et al. 2022 ). In contrast, the BS group showed only minor, non-significant alterations, indicating a limited effect on arch dimensions. Notably, while ( Fouda et al. 2022 ) reported slight increases in maxillary intermolar distance, the trial findings suggest a reduction in this parameter within the FPC group, possibly due to mesial molar movement. Limitations: Some limitations should be acknowledged, particularly the absence of a non-treated control group, which restricts the ability to separate treatment effects from normal growth patterns; however, ethical concerns prevent withholding treatment for AOB in growing patients. Additionally, the lack of a standardised sharpening protocol for bonded spurs may have affected their functional efficiency, as all appliances were delivered without modification due to safety concerns and the absence of clinical guidelines. Practical challenges were observed with both appliances: frequent detachment was noted in the BS group, potentially reducing its clinical efficiency, while the fixed palatal crib required higher maintenance, which may have affected patient comfort. These factors could have influenced patient cooperation and overall treatment response. Finally, while the 12-month follow-up provided valuable insight into short-term outcomes, it was insufficient to assess long-term stability and relapse risk. Conclusions The FPC appliance demonstrated superior outcomes in overbite correction and dentoalveolar changes compared to BS, with both appliances showing no significant skeletal effects. Considering the absence of standardised guidelines and concerns about tongue injury, future research should aim to establish safe, evidence-based sharpening protocols to optimise BS performance. Long-term follow-ups are also recommended to evaluate post-treatment stability and the role of appliance design in soft tissue adaptation. Declarations Author contributions : R.H. was responsible for coordinating the study, recruiting participants, managing group assignments, conducting the measurements, and drafting the initial manuscript. M.M. generated the randomisation sequence and supported data handling and protocol adherence. A.H. was primarily responsible for the overall study design and methodological planning, reviewed the randomisation process, verified the measurements independently, and ensured compliance with research standards. N.K. contributed to clinical supervision and follow-up monitoring. All authors revised the manuscript critically and approved the final submitted version. Funding: No financial assistance was obtained from any institution for the completion of this work Data Availability: Data generated or analysed in this study can be accessed upon reasonable requests from the corresponding author. Competing Interests: The authors declare no competing interests. Trial registration: This trial was registered at clinical trial.gov, ID: NCT05313399 . Ethical approval: The trial was approved by the Research Ethics Committee of the Faculty of Dentistry, Cairo University (Approval Date: 28/06/2022) and was conducted in alignment with the ethical standards of the Declaration of Helsinki. Consent to participate: Written informed consent was secured from all children’s parents or legal guardians before their enrolment in the trial. References Aliaga-Del Castillo A, Bellini-Pereira SA, Vilanova L, et al (2021) Dental arch changes after open bite treatment with spurs associated with posterior build-ups in the mixed dentition: A randomized clinical trial. Am J Orthod Dentofac Orthop 159:714–723. https://doi.org/10.1016/j.ajodo.2020.11.036 . Aliaga-Del Castillo A, Vilanova L, Miranda F, et al (2021) Dentoskeletal changes in open bite treatment using spurs and posterior build-ups: A randomized clinical trial. Am J Orthod Dentofac Orthop 159:10–20. https://doi.org/https://doi.org/10.1016/j.ajodo.2020.06.031 . Artese A, Drummond S, Nascimento JM do, Artese F (2011) Criteria for diagnosing and treating anterior open bite with stability. Dental Press J Orthod 16:136–161. https://doi.org/10.1590/S2176-94512011000300016 . Borrie FRP, Bearn DR, Innes NPT, Iheozor-Ejiofor Z (2015) Interventions for the cessation of non-nutritive sucking habits in children. Cochrane Database Syst Rev. 2015 Mar 31;2015(3):CD008694. doi: 10.1002/14651858.CD008694.pub2. PMID: 25825863; PMCID: PMC8482062. Canuto LFG, Janson G, De Lima NS, et al (2016b) Anterior open-bite treatment with bonded vs conventional lingual spurs: A comparative study. Am J Orthod Dentofac Orthop 149:847–855. https://doi.org/10.1016/j.ajodo.2015.11.026 . Davidson L (2008) Thumb and finger sucking. Pediatr Rev 29:207–208. https://doi.org/10.1542/pir.29-6-207 El-Sayed EM, Abdel Ghani AH (2019) Prevalence of the oral habits that cause anterior open-bite in Egyptian pre-adolescents (Cross-sectional study). Egypt Dent J 65:953–958. https://doi.org/10.21608/edj.2015.71990 . ElMotaleb MA, Dakroury AA, Sharaby F (2014) Prevalence of Anterior Open Bit e among Egyptian Adolescent Population. Aust J Basic Appl Sci 8:533–537. https://ajbasweb.com/old/ajbas/2014/January/533-537.pdf [Accessed 12 Mar. 2025]. Faul F, Erdfelder E, Lang A-G, Buchner A (2007) G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39:175–191. doi: 10.3758/bf03193146. PMID: 17695343. Fouda AS, Afify AK, Aboulfotouh MH, et al (2022) Dental arch changes after anterior open bite treatment in the mixed denftition produced by miniscrew-supported palatal crib vs conventional fixed palatal crib: A randomized clinical trial. Angle Orthod 92:487–496. https://doi.org/10.2319/082321-659.1 Fsifis MSS, El-Sayed FAA, Munir H (2016) Prevalence of malocclusion in primary schoolchildren of Cairo, Egypt (A survey study). Egypt Dent J 62:225–231. https://doi.org/10.21608/edj.2016.92661 . González Espinosa D, de Oliveira Moreira PE, da Sousa AS, et al (2020) Stability of anterior open bite treatment with molar intrusion using skeletal anchorage: a systematic review and meta-analysis. Prog Orthod 21:35. https://doi.org/10.1186/s40510-020-00328-2 Huang GJ, Justus R, Kennedy DB, Kokich VG (1990) Stability of anterior openbite treated with crib therapy. Angle Orthod 60:17–24. https://doi.org/10.1043/0003-3219(1990)0602.0.CO;2 . Iqbal MDK., Bhat M., Antony T. S V. (2019) Patient Compliance to Two Treatment Modalities for Tongue Thrust Habit-A Comparative Clinical. 2:42–46. https://researchnovelty.com/management_research/article_pdf/1554113327COSD-RA070319-12-1.pdf [Accessed 15 Apr. 2025]. Justus R (2001) Correction of Anterior Open Bite with Spurs: Long-Term Stability. World J Orthod 2 (3), 219–23 . Khayami S, Bennani F, Farella M (2013) Fingers in mouths: From cause to management. N Z Dent J109:49–54 . https://www.researchgate.net/publication/239943508_Fingers_in_mouths_from_cause_to_management [Accessed 10 Apr. 2025]. Koletsi D, Makou M, Pandis N (2018) Effect of orthodontic management and orofacial muscle training protocols on the correction of myofunctional and myoskeletal problems in developing dentition. A systematic review and meta-analysis. Orthod Craniofacial Res 21:202–215. https://doi.org/10.1111/ocr.12240 Leite JS, Matiussi LB, Salem AC, et al (2016) Effects of palatal crib and bonded spurs in early treatment of anterior open bite: A prospective randomized clinical study. Angle Orthod 86:734–739. https://doi.org/10.2319/031815-170.1 . Massler M, Chopra B (1950) The palatal crib for the correction of oral habits. J Dent Child 17:1–6 . https://doi.org/10.1016/j.jecm.2013.01.004 . Meng M, Xie Y, Cao J, et al (2022) Effects of bonded spurs, fixed and removable palatal crib in the early treatment of anterior open bite: A systematic review and meta-analysis. Am J Orthod Dentofac Orthop . Mar;163(3):298-310. doi: 10.1016/j.ajodo.2022.10.017. Epub 2022 Dec 21. PMID: 36564317. Mousa MR, Hajeer MY, Farah H (2021) Evaluation of the open-bite Bionator versus the removable posterior bite plane with a tongue crib in the early treatment of skeletal anterior open bite: A randomized controlled trial. J World Fed Orthod 10:163–171. https://doi.org/10.1016/j.ejwf.2021.08.001. Ngan P, Fields HW (1997) Open bite: a review of etiology and management. Pediatr Dent 19:91–98. Mar-Apr;19(2):91-8. PMID: 9106869. Nogueira FF, Mota LM, Nouer PRA, Nouer DF (2005) Nogueira® lingual bonded spur: supporting treatment of atypical swallow by lingual pressure. Rev Dent Press Ortod e Ortop Facial 10:129–156. https://doi.org/10.1590/S1415-54192005000200016. Otaren NJ, Umweni AA, Otuyemi OD, Ogbeide E (2021) Digit Sucking Habit: A Review of Literature. West African J Orthod 10:12–22. https://wajo.oauife.edu.ng/index.php/wajo/article/view/195/156 [Accessed 20 Mar. 2025]. Proffit WR, Fields HW SD (2007) Contemporary orthodontics, 4th ed. Missouri:Mosby Reddy D, Dawjee S (2019) Treatment of thumb-sucking habit using a fixed tongue crib appliance - a case report and literature review. South African Dent J 74:0–1. https://doi.org/10.17159/2519-0105/2019/v74no5a4 Rossato PH, Fernandes TMF, Urnau FDA, et al (2018) Dentoalveolar effects produced by different appliances on early treatment of anterior open bite: a randomized clinical trial. Angle Orthod 88:684–691. https://doi.org/10.2319/101317-691.1. Slaviero T, Fernandes TMF, Oltramari-Navarro PVP, et al (2017) Dimensional changes of dental arches produced by fixed and removable palatal cribs: A prospective, randomized, controlled study. Angle Orthod 87:215–222. Mar;87(2):215-222. doi: 10.2319/060116-438.1. Epub 2016 Sep 6. PMID: 27598906; PMCID: PMC8384369. Tavares CAE, Allgayer S (2019) Open bite in adult patients. Dental Press J Orthod 24:69–78. https://doi.org/10.1590/2177-6709.24.5.069-078.bbo Wang J, Banda AK, Kau CH, Huang GJ (2024) Craniofacial management of anterior openbite: a clinical review. Front Oral Maxillofac Med 6:26. doi: 10.21037/fomm-23-3. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6660641","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":456499313,"identity":"17843625-74e5-4fa8-8120-54aea4d3a458","order_by":0,"name":"Reem Shams","email":"data:image/png;base64,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","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Reem","middleName":"","lastName":"Shams","suffix":""},{"id":456499314,"identity":"844b050d-e7aa-4a33-a2da-f118025a72f5","order_by":1,"name":"Mai Ali","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Mai","middleName":"","lastName":"Ali","suffix":""},{"id":456499315,"identity":"4a285ab4-cf07-4949-b714-554182d41727","order_by":2,"name":"Nihal Kabel","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Nihal","middleName":"","lastName":"Kabel","suffix":""},{"id":456499316,"identity":"38065a47-047f-4754-9e32-c4cb8c11d142","order_by":3,"name":"Ahmed Elkhadem","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Ahmed","middleName":"","lastName":"Elkhadem","suffix":""}],"badges":[],"createdAt":"2025-05-14 05:38:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6660641/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6660641/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83030247,"identity":"eacc2073-5634-4a60-8c0c-c661c856cd34","added_by":"auto","created_at":"2025-05-19 08:57:38","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":396158,"visible":true,"origin":"","legend":"\u003cp\u003eCONSORT flow chart\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6660641/v1/3ad824071b1bdeaa3834d558.png"},{"id":83030253,"identity":"d7e46254-2a52-480f-967d-5c48a3467d66","added_by":"auto","created_at":"2025-05-19 08:57:38","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":528320,"visible":true,"origin":"","legend":"\u003cp\u003eDigital model illustrations showing the measured dental variables\u003cstrong\u003e \u003c/strong\u003e(a) Overbite. (b) Overjet. (c) Antero-posterior position of the upper first molar. (d) Vertical dental development. (e) Maxillary and mandibular arch length. (f) Maxillary and mandibular arch perimeter. (g) Intermolar Width.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-6660641/v1/35123a9bbd000b124c6ba1b0.png"},{"id":83031657,"identity":"840479e5-344a-4ccb-b8e1-923e2316af92","added_by":"auto","created_at":"2025-05-19 09:13:39","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":888106,"visible":true,"origin":"","legend":"\u003cp\u003eLateral cephalometric tracing illustrating anatomical landmarks and skeletal and dentoalveolar angular measurements used in orthodontic analysis. The key cephalometric points include: S (Sella), N (Nasion), A (A-point), B (B-point), Pog (Pogonion), Gn (Gnathion), Me (Menton), Go (Gonion), ANS (Anterior Nasal Spine), PNS (Posterior Nasal Spine), Or (Orbitale), Po (Porion) and LAFH (Lower Anterior Facial Height) and numbered angular variables include 1. SNA) Sella–Nasion–A point angle (2. SNB (Sella–Nasion–B point angle) 3. ANB (A point–Nasion–B point angle), 4. MMPA (Maxillary-mandibular plane angle), 5. Y-Axis,6. Mx1.PP (Maxillary central incisor to palatal plane angle), 7. IMPA (Mandibular central incisor to mandibular plane angle) and 8. 1.1(interincisal angle).\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-6660641/v1/1f8204930450f1df6da29ff6.png"},{"id":83031656,"identity":"c35be750-9238-4eb7-996d-c17bdcbdba71","added_by":"auto","created_at":"2025-05-19 09:13:38","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":517645,"visible":true,"origin":"","legend":"\u003cp\u003e(A) Intraoral pre-treatment pictures of FPC group patient. (B) Pictures taken in the middle of treatment. (C) Post-treatment\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-6660641/v1/5fa7bd0c47bf2c6db0e8df20.png"},{"id":83030775,"identity":"37559cb5-8bed-4c0e-9643-b04fa97ff3fc","added_by":"auto","created_at":"2025-05-19 09:05:38","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":582781,"visible":true,"origin":"","legend":"\u003cp\u003e(A) Intraoral pre-treatment pictures of BS group patient. (B) Pictures taken in the middle of treatment. (C) Post-treatment.\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-6660641/v1/686c67956c5949c717bb1b06.png"},{"id":83032452,"identity":"bcf57745-ac66-4593-8410-71b8ef982b93","added_by":"auto","created_at":"2025-05-19 09:21:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4747903,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6660641/v1/b620e31a-1269-40e7-89b4-22408e7cbc12.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eComparing Skeletal and Dentoalveolar Effects of Fixed Palatal Crib and Bonded Spurs in Early Management of Anterior Open Bite Associated with Non-Nutritive Sucking Habits: A Randomised Clinical Trial\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAnterior open bite (AOB) refers to a type of malocclusion characterised by a lack of vertical overlap between the upper and lower incisors, despite the posterior teeth maintaining occlusal contact \u003cb\u003e(\u003c/b\u003eTavares and Allgayer \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2019\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.​ It can be result from a combination of skeletal factors, such as excessive vertical facial growth, and environmental influences, including prolonged non-nutritive sucking habits and tongue-thrusting \u003cb\u003e(\u003c/b\u003eNgan and Fields \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e1997\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. In Egypt, AOB prevalence ranges between 1.6% and 20.9%, depending on age and gender \u003cb\u003e(\u003c/b\u003eElMotaleb et al. \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Fsifis et al. \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; El-Sayed and Abdel Ghani \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2019\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. The severity of AOB is classified according to the vertical separation between the upper and lower incisors: moderate (0\u0026ndash;2 mm), severe (3\u0026ndash;4 mm), and extreme when exceeding 4 mm \u003cb\u003e(Proffit WR, Fields HW 2007)\u003c/b\u003e. Anterior open bite is associated with a significantly increased risk of speech articulation errors, occurring 12 to 50 times more frequently than in individuals with normal occlusion, alongside a marked reduction in mastication efficiency by approximately 60\u0026ndash;72%, \u003cb\u003e(\u003c/b\u003eTavares and Allgayer \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2019\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. Relapse after correction is also common roughly 10\u0026ndash;30% of treated cases tend to reopen over time \u003cb\u003e(\u003c/b\u003eGonz\u0026aacute;lez Espinosa et al. \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2020\u003c/span\u003e)\u003cb\u003e​\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eTreatment approaches for AOB are generally categorised into three strategies: eliminating the aetiological habit (if present), correcting dental malocclusion, or addressing skeletal discrepancies through orthopaedic or surgical means, depending on the underlying cause and severity \u003cb\u003e(\u003c/b\u003eWang et al. \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). In early-diagnosed habit-related AOB, non-appliance methods such as behaviour modification and positive reinforcement are often first \u003cb\u003e(\u003c/b\u003eDavidson \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Borrie et al. \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). if non-appliance therapy fails to eliminate the habit, the use of habit-breaking appliances such as palatal cribs or spurs is advised to facilitate bite closure and correct the positioning of the tongue \u003cb\u003e(\u003c/b\u003eHuang et al. \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e1990\u003c/span\u003e; Justus \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2001\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. Fixed palatal crib was first introduced in the 1950s \u003cb\u003e(\u003c/b\u003eMassler and Chopra \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e1950\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e facilitating spontaneous bite closure and allowing normal incisor eruption \u003cb\u003e(Berger and Janisse 2013;\u003c/b\u003e Leite et al. \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). However, their use has been associated with challenges such as speech difficulties, oral hygiene complications, and tongue disco0mfort \u003cb\u003e(Iqbal MDK., Bhat M., Antony T. 2019)\u003c/b\u003e. Bonded spurs were introduced in 2005 as a less intrusive alternative, designed to be attached to the lingual or palatal surfaces of incisors \u003cb\u003e(\u003c/b\u003eNogueira et al. \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). They guide tongue posture through proprioceptive feedback, modifying tongue function without obstructing the oral space \u003cb\u003e(\u003c/b\u003eJustus \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2001\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eA systematic review by \u003cb\u003e(\u003c/b\u003eKoletsi et al. \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) emphasised the absence of robust evidence regarding early orthodontic interventions for AOB, and concluded that no evidence supported the superiority of bonded spurs over fixed banded appliances. Similarly, \u003cb\u003e(\u003c/b\u003eMeng et al. \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) reported that only two studies had directly compared fixed palatal cribs and bonded spurs, with limited and inconsistent evidence regarding their long-term outcomes and potential adverse effects, and inconclusive findings. Given these limitations, this trial aims to comprehensively examine the impact of fixed palatal cribs and bonded spurs on both skeletal and dentoalveolar structures, addressing gaps in previous research by incorporating a detailed analysis of arch dimensions and vertical skeletal changes in children with AOB due to non-nutritive sucking habits (NNSHs).\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eThe randomised clinical trial with parallel groups was conducted at the Outpatient Diagnostic Clinic, Department of Paediatric Dentistry and Dental Public Health, Faculty of Dentistry, Cairo University, from September 2022 to May 2023. Approval for the study\u0026rsquo;s ethical conduct was secured from the Research Ethics Committee of the Faculty of Dentistry, Cairo University, with clearance granted on 28/06/2022. The trial protocol was registered prospectively registered at ClinicalTrials.gov (Identifier: NCT05313399).\u003c/p\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eSample Size Calculation:\u003c/h2\u003e\n \u003cp\u003eSample size determination was conducted through a power analysis targeting the detection of differences in AOB correction between the fixed palatal crib (FPC) and bonded spurs (BS) groups. Based on a previous trial by \u003cstrong\u003e(\u003c/strong\u003eLeite et al. \u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e), the analysis incorporated an alpha level of 0.05, 80% statistical power, and an effect size of 1.23 (Cohen\u0026rsquo;s \u003cem\u003ed\u003c/em\u003e), derived from changes in overbite correction.. The smallest required sample size was calculated to be 24 participants. An additional 25% was added to the sample size, resulting in a final sample of 30 children, with 15 randomly assigned to each group to account for potential dropouts. Sample size estimation was performed using G*Power )version 3.1.9.7) \u003cstrong\u003e(\u003c/strong\u003eFaul et al. \u003cspan class=\"CitationRef\"\u003e2007\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eInclusion criteria:\u003c/h3\u003e\n\u003cp\u003eEligible participants were children aged 6 to 11 years AOB\u0026thinsp;\u0026ge;\u0026thinsp;1 mm associated with NNSHs, and tongue thrust were considered eligible. Only participants with fully erupted permanent upper and lower central incisors and a clinically confirmed Angle Class I molar relationship were included.\u003c/p\u003e\n\u003ch3\u003eExclusion Criteria:\u003c/h3\u003e\n\u003cp\u003eChildren exhibited craniofacial anomalies, developmental or systemic disorders, a history of orthodontic treatment, or previous extraction of permanent teeth due to trauma or caries.\u003c/p\u003e\n\u003ch3\u003eSubject Recruitment:\u003c/h3\u003e\n\u003cp\u003eRecruitment was conducted between September 2022 and May 2023. A total of 50 participants were initially screened for eligibility, 20 did not meet the predefined inclusion criteria and were therefore excluded. The remaining 30 eligible participants were randomly allocated into two groups: the fixed palatal crib (FPC) group and the bonded spurs (BS) group, with 15 children in each. The randomisation sequence was generated by M.M.A using \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ewww.random.org\u003c/span\u003e\u003c/span\u003e, and sealed opaque envelopes were prepared for allocation concealment, and R.H conducted group assignments, recorded participant details, and managed follow-up coordination. The randomisation protocol and overall study design were developed and approved by A.H, who ensured proper methodological planning and compliance. Follow-up was completed by May 2024 following the scheduled course of treatment. Participant flow is illustrated in the CONSORT flow chart \u003cstrong\u003e(\u003c/strong\u003eFig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cstrong\u003e)\u003c/strong\u003e. All 30 participants completed the one-year follow-up, with no dropouts.\u003c/p\u003e\n\u003ch3\u003eClinical Examination:\u003c/h3\u003e\n\u003cp\u003eBefore treatment, all participants underwent comprehensive clinical documentation, including intraoral and extraoral photographs, panoramic radiographs, digital lateral cephalometric radiographs, and digital biomodels were generated by scanning stone dental casts using the Medit i500 scanner (Medit Corp., Seoul, South Korea), which produced stereolithographic (STL) files for analysis The clinical assessment included evaluation of anterior open bite, molar relationship, tongue thrust, and oral habits. Additionally, a preparatory behavioural phase was implemented, during which each child received oral hygiene instructions and caries control.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eBlinding:\u003c/h2\u003e\n \u003cp\u003eBlinding was implemented for the outcome assessors; however, it was not feasible for the operator or patients due to the visible nature of the interventions.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eInterventions:\u003c/h3\u003e\n\u003cp\u003eBonded spurs (Tongue Tamers\u0026reg;, Ortho Technology, Tampa FL) were placed on the palatal surfaces of the maxillary incisors and the lingual surfaces of the mandibular incisors, positioned at the cervical and incisal thirds respectively, to reduce potential occlusal interference. Attachment of the spurs was achieved using Transbond\u0026trade; XT (3M Unitek, St. Paul, MN, USA), a light-cured orthodontic adhesive after acid etching to ensure optimal retention \u003cstrong\u003e(\u003c/strong\u003eJustus \u003cspan class=\"CitationRef\"\u003e2001\u003c/span\u003e; Leite et al. \u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e; Aliaga-Del Castillo et al. \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e). The FPC was fabricated by adapting bands (Ormco Corporation, Glendora, CA, USA) with a 0.9 mm wire loop soldered to extend between the maxillary canines. Orthodontic separators were placed to ensure a proper fit before cementation. Glass ionomer cement (Medicem glass ionomer, Promedica Dental Material GmbH, Germany) was used for secure attachment \u003cstrong\u003e(\u003c/strong\u003eLeite et al. \u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e). Participants who failed to show adequate improvement in AOB or required additional management were referred for fixed appliance therapy to ensure appropriate clinical care.\u003c/p\u003e\n\u003ch3\u003eOutcome Measures:\u003c/h3\u003e\n\u003cp\u003eThe primary outcome of this trial was overbite correction, measured in millimeters using digital bio models derived from intraoral scans of dental casts. A secondary outcome was the achievement of a positive overbite (i.e., incisal overlap), regarded in previous studies \u003cstrong\u003e(\u003c/strong\u003eSlaviero et al. \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e; Aliaga-Del Castillo et al. \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e) as a reliable clinical indicator of successful AOB correction. Secondary outcomes also included changes in arch dimensions, which were evaluated via digital biomodels, and vertical skeletal changes were assessed through lateral cephalograms. Digital biomodels were analysed using OrthoAnalyzer 3D software (3Shape, Copenhagen, Denmark) to quantify changes in overbite, arch length, arch perimeter, vertical development and intermolar distance \u003cstrong\u003e(\u003c/strong\u003eFig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cstrong\u003e)\u003c/strong\u003e. Lateral cephalometric analysis was performed using Dolphin Imaging Software Version 11.5 (Dolphin\u0026reg; Imaging and Management Solutions, Patterson Dental Supply, Inc., Chatsworth, CA) was assessed skeletal and dentoalveolar changes by evaluating the maxillary-mandibular plane angle (MMPA) along with other dentoalveolar parameters (Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). The detailed description of all measured variables is provided in \u003cstrong\u003e(\u003c/strong\u003eTable \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cstrong\u003e(\u003c/strong\u003e. Digital biomodels and cephalometric measurements were primarily conducted by R.H and independently verified by A.H, both trained and calibrated in the use of the respective software tools.\u003c/p\u003e\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eLinear measurements on digital models.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMeasurement Type\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDefinition\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"10\"\u003e\n \u003cp\u003eDigital Cast Measurements\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eDental relationship, mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverbite\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThe vertical overlap is measured from the incisal edge of the upper central incisor to the corresponding surface of the lower incisor.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverjet\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThe horizontal gap between the labial surface of the upper incisor and that of the lower incisor, assessed in a parallel plane to the occlusal surface.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e(U6-rugae)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDistance from the mesial surface of the upper first molar (U6) to a line intersecting the right and left third palatal rugae.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eVertical development, mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMx and Md anterior dentoalveolar vertical development\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThe vertical measurement represents the perpendicular span from the alveolar ridge at the contact point (or midpoint in cases of spacing) between the central incisors, extending occlusally in a frontal projection. The occlusal reference plane was determined by connecting the mesiobuccal cusps of the permanent first molars with the cusp tips of either the deciduous first molars or the first premolars on each side of the maxilla and mandible.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eArch dimensions, mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eArch perimeter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThe total arch length is determined by summing four linear segments starting at the mesial surface of the permanent first molars, extending through the deciduous canines to the central incisors on each side.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eArch length\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThe shortest linear distance drawn perpendicularly from a horizontal line connecting the mesial aspects of the first molars to the point of contact, or midpoint, between the central incisors at the gingival margin.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u0026ndash;6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThe linear distance between the first permanent molars measured at the midpoint of the palatal or lingual gingival margin.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"11\"\u003e\n \u003cp\u003eLateral Cephalometric Measurements\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eDental relationship\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThis angle is measured at the point where the long axes of the upper and lower central incisors intersect.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaxillomandibular relationship\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eANB (˚)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCalculated by subtracting the SNB angle from the SNA angle, this measurement indicates the anteroposterior positional relationship between the maxilla and mandible.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eVertical components\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eY-axis (˚)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThe line connecting Sella to Gnathion is an estimate of the direction of mandibular growth.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLAFH (mm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRepresents the vertical facial height measured between the anterior nasal spine (ANS) and menton (Me), indicating the vertical dimension of the lower facial third.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMMPA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThe angular relationship between the palatal plane (spanning from ANS to PNS) and the mandibular plane (from Gonion to Menton), reflecting the vertical skeletal pattern.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaxillary and Mandibular dentoalveolar components\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMx1.PP (˚)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThis is the angular relationship between the upper incisor\u0026rsquo;s axis and the palatal plane, which reflects the degree of maxillary incisor inclination.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eIMPA (˚)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThe angular distance between the axis of the lower central incisor and the mandibular plane, indicating the extent of incisor proclination or retroclination.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e[1] U6-rugae: Antero-posterior position of the upper first molar, \u0026nbsp;Mx Ver: Maxillary vertical development, Md Ver Mandibular vertical development,6-6: Inter first permanent molars width, 1.1: interincisal angle, ANB: A point\u0026ndash;Nasion\u0026ndash;B point angle, LAFH: Lower Anterior Facial Height, MMPA: Maxillary-mandibular plane angle, Mx1\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003ePP: Maxillary central incisor to palatal plane angle and IMPA: Mandibular central incisor to mandibular plane angle.\u003c/p\u003e\n\u003ch2\u003eData processing and analysis:\u003c/h2\u003e\n\u003cp\u003eStatistical evaluation was conducted using SPSS\u0026reg; software (version 20, IBM Corp., Armonk, NY, USA). Data normality was verified through the Kolmogorov\u0026ndash;Smirnov and Shapiro\u0026ndash;Wilk tests, confirming the suitability for parametric analysis. The paired t-test was applied to compare pre-and post-treatment values within each group, while intergroup differences were analysed using the independent t-test. A significance level was set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0. 05. To compare categorical variables, such as treatment success (i.e., positive overbite), the chi-square test was utilised. Relative risk (RR) and the corresponding 95% confidence intervals were also computed and reported. To verify intra- and inter-observer reliability, measurements from 10% of the digital biomodels and lateral cephalograms were re-evaluated by the same independent observer one month after initial analysis. Intraclass correlation coefficients (ICCs) were calculated, yielding values of 0.93 for intra-observer and 0.91 for inter-observer reliability, indicating excellent agreement. No modifications were made to the trial outcomes after the study commenced.\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\"\u003e\n \u003ch2\u003eBaseline Data:\u003c/h2\u003e\n \u003cp\u003eDemographic characteristics such as age and gender for both groups are presented in \u003cstrong\u003e(Table\u0026nbsp;2)\u003c/strong\u003e.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\"\u003e\n \u003ch2\u003eNumbers Analysed:\u003c/h2\u003e\n \u003cp\u003eTwelve months post-treatment, digital biomodel evaluation revealed notable alterations within the FPC group. Overbite increased significantly by 3.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0. mm \u003cstrong\u003e(\u003c/strong\u003eFig.\u0026nbsp;4\u003cstrong\u003e)\u003c/strong\u003e, with a mesial movement of the upper first molars (1.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83 mm). Additionally, arch dimensions were reduced, with mandibular arch perimeter (MdAP), maxillary arch length (MxAL), mandibular arch length (MdAL) and maxillary intermolar width distance (Mx6-6) decreasing by 2.46\u0026thinsp;\u0026plusmn;\u0026thinsp;1.51 mm, 1.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22 mm, 1.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27 mm, and 0.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62 mm, respectively \u003cstrong\u003e(\u003c/strong\u003eTable\u0026nbsp;3\u003cstrong\u003e)\u003c/strong\u003e. These dentoalveolar modifications, identified through digital biomodels as changes in tooth position and alveolar bone without skeletal base involvement, contributed to a significantly higher proportion of patients achieving a positive overbite in the FPC group (73.33%) compared to the BS group (6.67%), indicating that patients treated with FPC were 11 times more likely to achieve overbite correction, with a relative risk of 11.0 (95% CI: 1.62\u0026ndash;74.88). In contrast, the BS group exhibited a significant increase in overbite by 1.89\u0026thinsp;\u0026plusmn;\u0026thinsp;1.00 mm \u003cstrong\u003e(\u003c/strong\u003eFig.\u0026nbsp;5\u003cstrong\u003e)\u003c/strong\u003e, while maxillary vertical development showed a significant decrease by 0.98\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04 mm \u003cstrong\u003e(\u003c/strong\u003eTable\u0026nbsp;4\u003cstrong\u003e)\u003c/strong\u003e.\u003c/p\u003e\n \u003cdiv align=\"left\"\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e The baseline demographic data, including age and gender, for each group.\u003c/div\u003e\n \u003cp\u003e\u003cimg 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\"\u003e\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003ePre- and post-treatment means, standard deviations) SD), and the outcomes of paired t-tests assessing the treatment-related differences in the FPC group.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eMeasurement Type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ePre-treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ePost-treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eChange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e95%CI for the change\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e- Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLower Bound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUpper bound\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"14\"\u003e\n \u003cp\u003eDigital Cast Measurements\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"10\"\u003e\n \u003cp\u003e\u003cstrong\u003eDental Relationship\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOverbite (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00155**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOverjet (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.34021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eU6-rugae (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.01998*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"10\"\u003e\n \u003cp\u003e\u003cstrong\u003eVertical Development\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMx Ver (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.07553\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMd Ver (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.25359\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"10\"\u003e\n \u003cp\u003e\u003cstrong\u003eArch Dimension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMxAp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-3.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.74382\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMdAP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-3.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00002***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMxAL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00046***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMdAL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00000***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMx6-6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00392**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMd6-6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.76674\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"11\"\u003e\n \u003cp\u003eLateral Cephalometric Measurements\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"10\"\u003e\n \u003cp\u003e\u003cstrong\u003eDental Relationship\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.1(˚)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e109.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e115.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00260**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"10\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaxillomandibular relationship\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eANB (˚)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.64610\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"10\"\u003e\n \u003cp\u003e\u003cstrong\u003eVertical components\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eY-axis (˚)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.64610\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMMPA (˚)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.55299\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLAFH (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.33068\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"10\"\u003e\n \u003cp\u003e\u003cstrong\u003eDentoalveolar Measurements\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMx1.PP (˚)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e119.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e120.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.77647\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIMPA (˚)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-7.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-9.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-4.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00006***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"11\"\u003e\u003cem\u003ep\u003c/em\u003e-values interpretation: * \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.05: significant; ** \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.01: highly significant; *** \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.001: very highly significant; ns: non-significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). CI: confidence interval\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eLateral cephalometric analysis confirmed significant dentoalveolar changes in both groups. In the FPC group, a significant reduction in incisor mandibular plane angle (IMPA) by 7.13\u0026thinsp;\u0026plusmn;\u0026thinsp;4.86\u0026deg; was observed, accompanied by an increase in the interincisal angle (1.1) by 6.39\u0026thinsp;\u0026plusmn;\u0026thinsp;6.77\u0026deg;, reflecting significant incisor inclination changes \u003cstrong\u003e(\u003c/strong\u003eTable\u0026nbsp;3\u003cstrong\u003e)\u003c/strong\u003e. In the BS group, no cephalometric variables showed statistically significant changes \u003cstrong\u003e(\u003c/strong\u003eTable\u0026nbsp;4\u003cstrong\u003e)\u003c/strong\u003e.\u003c/p\u003e\n \u003cp\u003eComparative analysis \u003cstrong\u003e(\u003c/strong\u003eTable\u0026nbsp;5\u003cstrong\u003e)\u003c/strong\u003e revealed that the FPC group achieved greater improvements in overbite correction compared to the BS group, with a mean difference of 1.22\u0026thinsp;\u0026plusmn;\u0026thinsp;2.18 mm. Additionally, IMPA reduction was significantly greater in the FPC group by 6.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.65\u0026deg;, indicating a more pronounced effect on incisor inclination and overall dentoalveolar changes. The FPC group also demonstrated a significantly greater increase in the interincisal angle (6.12\u0026thinsp;\u0026plusmn;\u0026thinsp;2.61\u0026deg;) compared to the BS group. Regarding arch dimensional changes, the FPC group exhibited significantly greater reductions, with MdAP decreasing by 2.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79 mm, MxAL by 1.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35 mm, and MdAL by 1.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30 mm. Additionally, the Mx6-6 was reduced by 0.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24 mm. However, skeletal parameters, including MMPA, exhibited no statistically significant differences found between groups, with a minimal mean change of 1.56\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22\u0026deg;, indicating no significant alterations in vertical skeletal relationships across treatment modalities.\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 4\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003ePre- and post-treatment means, standard deviations (SD), and the outcomes of paired t-tests assessing the treatment-related differences in the BS group.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eMeasurement Type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ePre-treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ePost-treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eChange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e95%CI for the change\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e - Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLower Bound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUpper bound\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"14\"\u003e\n \u003cp\u003eDigital Cast Measurements\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"10\"\u003e\n \u003cp\u003e\u003cstrong\u003eDental Relationship\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOverbite (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-3.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00000***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOverjet (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.81086\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eU6-rugae (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.78825\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"10\"\u003e\n \u003cp\u003e\u003cstrong\u003eVertical Development\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMx Ver (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00254**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMd Ver (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.44328\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"10\"\u003e\n \u003cp\u003e\u003cstrong\u003eArch Dimension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMxAp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.44328\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMdAP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.87747\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMxAL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.42043\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMdAL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.17724\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMx6-6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.39676\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMd6-6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.99691\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"11\"\u003e\n \u003cp\u003eLateral Cephalometric Measurements\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"10\"\u003e\n \u003cp\u003e\u003cstrong\u003eDental Relationship\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.1(˚)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e112.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e112.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-3.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.89008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"10\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaxillomandibular relationship\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eANB (˚)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.41474\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"10\"\u003e\n \u003cp\u003e\u003cstrong\u003eVertical components\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eY-axis (˚)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.44580\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMMPA (˚)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-3.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.27522\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLAFH (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.77917\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"10\"\u003e\n \u003cp\u003e\u003cstrong\u003eDentoalveolar Measurements\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMx1.PP (˚)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e117.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e118.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-3.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.52424\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIMPA (˚)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e96.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.52424\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"11\"\u003e\u003cem\u003ep\u003c/em\u003e-values interpretation: * \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.05: significant; ** \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.01: highly significant; *** \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.001: very highly significant; ns: non-significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). CI: confidence interval\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 5\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eMean values, standard deviations (SD), and outcomes of independent t-tests comparing changes across the two groups.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMeasurement Type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eFPC -BS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e95%CI for the change\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e- Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLower Bound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUpper bound\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"16\"\u003e\n \u003cp\u003eDigital Cast Measurements\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eDental Relationship\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOverbite (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00387**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOverjet (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.92783\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eU6-rugae (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.01097*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eVertical Development\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMx Ver (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.99691\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMd Ver (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.99691\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eArch Dimension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMxAp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-3.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.68547\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMdAP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-4.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00314**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMxAL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00013***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMdAL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMx6-6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00652**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMd6-6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.85891\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eDental Relationship\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.1(˚)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.02654*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"9\"\u003e\n \u003cp\u003eLateral Cephalometric Measurements\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaxillomandibular relationship\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eANB (˚)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.35323\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eVertical components\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eY-axis (˚)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.10996\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMMPA (˚)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.21103\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLAFH (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.21103\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eDentoalveolar Measurements\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMx1.PP (˚)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-6.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.69013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIMPA (˚)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-6.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-10.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-3.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00032***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003e\u003cem\u003ep\u003c/em\u003e-values interpretation: * \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.05: significant; ** \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.01: highly significant; *** \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.001: very highly significant; ns: non-significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). CI: confidence interval\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\"\u003e\n \u003ch2\u003eHarms:\u003c/h2\u003e\n \u003cp\u003eThe complications in the FPC group included some patients feeling discomfort due to the embedding of the appliance into the soft palate tissue, which led to pain and injury in that tissue. In the BS group, debonding was reported in 86.67% of patients, with an average of 0.87 debonding events per patient throughout the trial period. Some spurs were swallowed during meals, raising concerns among patients. Additionally, plaque accumulation around the spurs was observed despite oral hygiene instructions.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eProlonged NNSHs can lead to dentomaxillofacial abnormalities like an AOB \u003cb\u003e(\u003c/b\u003eArtese et al. \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Early intervention is crucial to intercept and correct these habits, preventing further dental arch and occlusal deviations while preventing the progression of AOB \u003cb\u003e(\u003c/b\u003eOtaren et al. \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Habit-breaking appliances like lingual spurs and palatal cribs act as effective intraoral reminders to discourage the habit \u003cb\u003e(\u003c/b\u003eKhayami et al. \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Reddy and Dawjee \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2019\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. A systematic review \u003cb\u003e(\u003c/b\u003eMeng et al. \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) identified only four studies evaluating the effects of FPC and BS in managing AOB, with just two directly comparing these appliances. Most existing research has focused primarily on overbite correction, while changes in arch dimensions and vertical skeletal changes remain insufficiently investigated. Given these gaps, this trial provides a comprehensive evaluation of the skeletal and dentoalveolar impacts of FPC and BS, offering clinicians evidence-based guidance for selecting the most effective approach in early AOB intervention.\u003c/p\u003e \u003cp\u003eThe statistical analysis showed that while both FPC and BS groups had significant overbite improvements, the FPC group was significantly more effective, allowing the rejection of the null hypothesis. This trial considered the achievement of a positive overbite as a clinically acceptable indicator of successful AOB correction. Although the FPC group showed superior success compared to the BS group, the overall percentages were lower than those reported by \u003cb\u003e(\u003c/b\u003eLeite et al. \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), who documented a 100% success rate with FPC and 53.8% with BS. \u003cb\u003e(\u003c/b\u003eRossato et al. \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) also reported modest success across appliance types, suggesting that differences in appliance design, and follow-up periods may account for these variations.\u003c/p\u003e \u003cp\u003e The effectiveness of FPC can be attributed to its design, which blocks tongue projection and disrupts harmful oral habits. In contrast, the failure in the BS group may be due to the absence of a sharpening procedure for the spurs, as recommended by \u003cb\u003e(\u003c/b\u003eJustus \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2001\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. This procedure was not implemented due to the absence of standardised guidelines and concerns over potential tongue injury. As a result, we think patients gradually adapted to the spurs, reducing their effectiveness over time as the tongue gets accustomed to the spurs. Thus, the secondary tongue thrusting would not be resolved over time with BS. Furthermore, the high debonding rate of BS (86.67%) in our sample introduced practical challenges, as frequent appliance detachment likely contributed to lower patient compliance and compromised treatment stability.\u003c/p\u003e \u003cp\u003ePrevious studies have reported overbite improvements of 3.95 mm for FPC and 3.07 mm for BS \u003cb\u003e(\u003c/b\u003eLeite et al. \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), as well as 3.60 mm for FPC and 3.09 mm for BS \u003cb\u003e(\u003c/b\u003eRossato et al. \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), indicating a generally comparable performance between both appliances in AOB correction. However, some studies have reported greater improvements with BS (4.26 mm and 4.38 mm) \u003cb\u003e(Canuto et al. 2016;\u003c/b\u003e Aliaga-Del Castillo et al. \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), suggesting that clinical conditions may influence its effectiveness. Although bonded spurs produced a statistically significant improvement in overbite, the degree of correction observed in this trial was notably lower than previously reported values. Its intermittent mode of action may explain this, as BS relies mainly on proprioceptive feedback rather than physical interference, unlike FPC, which provides continuous mechanical interference against tongue thrusting.\u003c/p\u003e \u003cp\u003ePrevious studies \u003cb\u003e(Canuto et al. 2016;\u003c/b\u003e Leite et al. \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Rossato et al. \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) reported no significant changes in skeletal variables, aligning with the findings of this study. This pattern aligns with previous studies reporting minimal skeletal effects, indicating that the observed changes may be related more to dentoalveolar adaptations than to skeletal alterations. However, \u003cb\u003e(\u003c/b\u003eMousa et al. \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) observed a significant reduction in MMPA by 6.69\u0026deg; involving the use of a tongue crib in combination with a removable posterior bite plane, emphasising how treatment approaches and appliance types may impact skeletal modifications.\u003c/p\u003e \u003cp\u003eThe FPC group showed a significantly greater reduction in IMPA, reinforcing previous findings of 5.51\u0026deg; \u003cb\u003e(\u003c/b\u003eLeite et al. \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) and 5.52\u0026deg; \u003cb\u003e(\u003c/b\u003eRossato et al. \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) but demonstrating an even more substantial effect in this trial. This notable retroclination of the mandibular incisors can be attributed to unopposed pressure from the lower lip during swallowing, a mechanism reinforced by the crib appliance\u0026rsquo;s design, which restricts tongue thrusting and promotes incisor repositioning. The BS group, however, showed minimal IMPA changes, even lower than past studies; 1.93\u0026deg; \u003cb\u003e(\u003c/b\u003eLeite et al. \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) and 0.91\u0026deg; \u003cb\u003e(\u003c/b\u003eRossato et al. \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), reinforcing concerns about its limited ability to control incisor inclination. This reduction in the FPC group contributed to an increase in the interincisal angle, aligning with prior reports of 9.65\u0026deg; \u003cb\u003e(\u003c/b\u003eRossato et al. \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), reflecting its role in improving dental alignment. In contrast, the BS group failed to demonstrate meaningful interincisal angle changes, contrary to earlier reports of 3.34\u0026deg; \u003cb\u003e(\u003c/b\u003eLeite et al. \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), suggesting greater variability in its clinical performance than previously assumed.\u003c/p\u003e \u003cp\u003eMesial displacement of the upper first molars was also noted in the FPC group, likely resulting from sustained tongue pressure exerted behind the appliance loops. This pressure-induced shift aligns with previous findings by \u003cb\u003e(\u003c/b\u003eFouda et al. \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) and reinforces the influence of tongue posture on dental arch adaptations. Additionally, reductions in MdAP, MxAL, and MdAL align with previous findings linking these changes to molar repositioning and lower incisor retroclination (Fouda et al. \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). In contrast, the BS group showed only minor, non-significant alterations, indicating a limited effect on arch dimensions. Notably, while \u003cb\u003e(\u003c/b\u003eFouda et al. \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) reported slight increases in maxillary intermolar distance, the trial findings suggest a reduction in this parameter within the FPC group, possibly due to mesial molar movement.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eLimitations:\u003c/h2\u003e \u003cp\u003eSome limitations should be acknowledged, particularly the absence of a non-treated control group, which restricts the ability to separate treatment effects from normal growth patterns; however, ethical concerns prevent withholding treatment for AOB in growing patients. Additionally, the lack of a standardised sharpening protocol for bonded spurs may have affected their functional efficiency, as all appliances were delivered without modification due to safety concerns and the absence of clinical guidelines. Practical challenges were observed with both appliances: frequent detachment was noted in the BS group, potentially reducing its clinical efficiency, while the fixed palatal crib required higher maintenance, which may have affected patient comfort. These factors could have influenced patient cooperation and overall treatment response. Finally, while the 12-month follow-up provided valuable insight into short-term outcomes, it was insufficient to assess long-term stability and relapse risk.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe FPC appliance demonstrated superior outcomes in overbite correction and dentoalveolar changes compared to BS, with both appliances showing no significant skeletal effects. Considering the absence of standardised guidelines and concerns about tongue injury, future research should aim to establish safe, evidence-based sharpening protocols to optimise BS performance. Long-term follow-ups are also recommended to evaluate post-treatment stability and the role of appliance design in soft tissue adaptation.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003cspan dir=\"RTL\"\u003e:\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eR.H. was responsible for coordinating the study, recruiting participants, managing group assignments, conducting the measurements, and drafting the initial manuscript. M.M. generated the randomisation sequence and supported data handling and protocol adherence. A.H. was primarily responsible for the overall study design and methodological planning, reviewed the randomisation process, verified the measurements independently, and ensured compliance with research standards. N.K. contributed to clinical supervision and follow-up monitoring. All authors revised the manuscript critically and approved the final submitted version.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e No financial assistance was obtained from any institution for the completion of this work\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability:\u003c/strong\u003e Data generated or analysed in this study can be accessed upon reasonable requests from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting\u003cspan dir=\"RTL\"\u003e \u003c/span\u003eInterests:\u003c/strong\u003e The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration:\u0026nbsp;\u003c/strong\u003eThis trial was registered at clinical trial.gov, ID: NCT05313399\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval:\u0026nbsp;\u003c/strong\u003eThe trial was approved by the Research Ethics Committee of the Faculty of Dentistry, Cairo University (Approval Date: 28/06/2022) and was conducted in alignment with the ethical standards of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u003c/strong\u003e Written informed consent was secured from all children\u0026rsquo;s parents or legal guardians before their enrolment in the trial.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAliaga-Del Castillo A, Bellini-Pereira SA, Vilanova L, et al (2021) Dental arch changes after open bite treatment with spurs associated with posterior build-ups in the mixed dentition: A randomized clinical trial. Am J Orthod Dentofac Orthop 159:714\u0026ndash;723. https://doi.org/10.1016/j.ajodo.2020.11.036\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eAliaga-Del Castillo A, Vilanova L, Miranda F, et al (2021) Dentoskeletal changes in open bite treatment using spurs and posterior build-ups: A randomized clinical trial. Am J Orthod Dentofac Orthop 159:10\u0026ndash;20. https://doi.org/https://doi.org/10.1016/j.ajodo.2020.06.031\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eArtese A, Drummond S, Nascimento JM do, Artese F (2011) Criteria for diagnosing and treating anterior open bite with stability. Dental Press J Orthod 16:136\u0026ndash;161. https://doi.org/10.1590/S2176-94512011000300016\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eBorrie FRP, Bearn DR, Innes NPT, Iheozor-Ejiofor Z (2015) Interventions for the cessation of non-nutritive sucking habits in children. Cochrane Database Syst Rev. 2015 Mar 31;2015(3):CD008694. doi: 10.1002/14651858.CD008694.pub2. PMID: 25825863; PMCID: PMC8482062.\u003c/li\u003e\n\u003cli\u003eCanuto LFG, Janson G, De Lima NS, et al (2016b) Anterior open-bite treatment with bonded vs conventional lingual spurs: A comparative study. Am J Orthod Dentofac Orthop 149:847\u0026ndash;855. https://doi.org/10.1016/j.ajodo.2015.11.026\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eDavidson L (2008) Thumb and finger sucking. Pediatr Rev 29:207\u0026ndash;208. https://doi.org/10.1542/pir.29-6-207\u003c/li\u003e\n\u003cli\u003eEl-Sayed EM, Abdel Ghani AH (2019) Prevalence of the oral habits that cause anterior open-bite in Egyptian pre-adolescents (Cross-sectional study). Egypt Dent J 65:953\u0026ndash;958. https://doi.org/10.21608/edj.2015.71990\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eElMotaleb MA, Dakroury AA, Sharaby F (2014) Prevalence of Anterior Open Bit e among Egyptian Adolescent Population. Aust J Basic Appl Sci 8:533\u0026ndash;537. https://ajbasweb.com/old/ajbas/2014/January/533-537.pdf [Accessed 12 Mar. 2025].\u003c/li\u003e\n\u003cli\u003eFaul F, Erdfelder E, Lang A-G, Buchner A (2007) G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39:175\u0026ndash;191. doi: 10.3758/bf03193146. PMID: 17695343.\u003c/li\u003e\n\u003cli\u003eFouda AS, Afify AK, Aboulfotouh MH, et al (2022) Dental arch changes after anterior open bite treatment in the mixed denftition produced by miniscrew-supported palatal crib vs conventional fixed palatal crib: A randomized clinical trial. Angle Orthod 92:487\u0026ndash;496. https://doi.org/10.2319/082321-659.1\u003c/li\u003e\n\u003cli\u003eFsifis MSS, El-Sayed FAA, Munir H (2016) Prevalence of malocclusion in primary schoolchildren of Cairo, Egypt (A survey study). Egypt Dent J 62:225\u0026ndash;231. https://doi.org/10.21608/edj.2016.92661\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eGonz\u0026aacute;lez Espinosa D, de Oliveira Moreira PE, da Sousa AS, et al (2020) Stability of anterior open bite treatment with molar intrusion using skeletal anchorage: a systematic review and meta-analysis. Prog Orthod 21:35. https://doi.org/10.1186/s40510-020-00328-2\u003c/li\u003e\n\u003cli\u003eHuang GJ, Justus R, Kennedy DB, Kokich VG (1990) Stability of anterior openbite treated with crib therapy. Angle Orthod 60:17\u0026ndash;24. https://doi.org/10.1043/0003-3219(1990)060\u0026lt;0017:SOAOTW\u0026gt;2.0.CO;2\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eIqbal MDK., Bhat M., Antony T. S V. (2019) Patient Compliance to Two Treatment Modalities for Tongue Thrust Habit-A Comparative Clinical. 2:42\u0026ndash;46. https://researchnovelty.com/management_research/article_pdf/1554113327COSD-RA070319-12-1.pdf [Accessed 15 Apr. 2025].\u003c/li\u003e\n\u003cli\u003eJustus R (2001) Correction of Anterior Open Bite with Spurs: Long-Term Stability. World J Orthod 2 (3), 219\u0026ndash;23\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eKhayami S, Bennani F, Farella M (2013) Fingers in mouths: From cause to management. N Z Dent J109:49\u0026ndash;54\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e https://www.researchgate.net/publication/239943508_Fingers_in_mouths_from_cause_to_management [Accessed 10 Apr. 2025].\u003c/li\u003e\n\u003cli\u003eKoletsi D, Makou M, Pandis N (2018) Effect of orthodontic management and orofacial muscle training protocols on the correction of myofunctional and myoskeletal problems in developing dentition. A systematic review and meta-analysis. Orthod Craniofacial Res 21:202\u0026ndash;215. https://doi.org/10.1111/ocr.12240\u003c/li\u003e\n\u003cli\u003eLeite JS, Matiussi LB, Salem AC, et al (2016) Effects of palatal crib and bonded spurs in early treatment of anterior open bite: A prospective randomized clinical study. Angle Orthod 86:734\u0026ndash;739. https://doi.org/10.2319/031815-170.1\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eMassler M, Chopra B (1950) The palatal crib for the correction of oral habits. J Dent Child 17:1\u0026ndash;6\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e https://doi.org/10.1016/j.jecm.2013.01.004\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eMeng M, Xie Y, Cao J, et al (2022) Effects of bonded spurs, fixed and removable palatal crib in the early treatment of anterior open bite: A systematic review and meta-analysis. Am J Orthod Dentofac Orthop\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e Mar;163(3):298-310. doi: 10.1016/j.ajodo.2022.10.017. Epub 2022 Dec 21. PMID: 36564317.\u003c/li\u003e\n\u003cli\u003eMousa MR, Hajeer MY, Farah H (2021) Evaluation of the open-bite Bionator versus the removable posterior bite plane with a tongue crib in the early treatment of skeletal anterior open bite: A randomized controlled trial. J World Fed Orthod 10:163\u0026ndash;171. https://doi.org/10.1016/j.ejwf.2021.08.001.\u003c/li\u003e\n\u003cli\u003eNgan P, Fields HW (1997) Open bite: a review of etiology and management. Pediatr Dent 19:91\u0026ndash;98. Mar-Apr;19(2):91-8. PMID: 9106869.\u003c/li\u003e\n\u003cli\u003eNogueira FF, Mota LM, Nouer PRA, Nouer DF (2005) Nogueira\u0026reg; lingual bonded spur: supporting treatment of atypical swallow by lingual pressure. Rev Dent Press Ortod e Ortop Facial 10:129\u0026ndash;156. https://doi.org/10.1590/S1415-54192005000200016.\u003c/li\u003e\n\u003cli\u003eOtaren NJ, Umweni AA, Otuyemi OD, Ogbeide E (2021) Digit Sucking Habit: A Review of Literature. West African J Orthod 10:12\u0026ndash;22. https://wajo.oauife.edu.ng/index.php/wajo/article/view/195/156 [Accessed 20 Mar. 2025].\u003c/li\u003e\n\u003cli\u003eProffit WR, Fields HW SD (2007) Contemporary orthodontics, 4th ed. Missouri:Mosby\u003c/li\u003e\n\u003cli\u003eReddy D, Dawjee S (2019) Treatment of thumb-sucking habit using a fixed tongue crib appliance - a case report and literature review. South African Dent J 74:0\u0026ndash;1. https://doi.org/10.17159/2519-0105/2019/v74no5a4\u003c/li\u003e\n\u003cli\u003eRossato PH, Fernandes TMF, Urnau FDA, et al (2018) Dentoalveolar effects produced by different appliances on early treatment of anterior open bite: a randomized clinical trial. Angle Orthod 88:684\u0026ndash;691. https://doi.org/10.2319/101317-691.1.\u003c/li\u003e\n\u003cli\u003eSlaviero T, Fernandes TMF, Oltramari-Navarro PVP, et al (2017) Dimensional changes of dental arches produced by fixed and removable palatal cribs: A prospective, randomized, controlled study. Angle Orthod 87:215\u0026ndash;222. Mar;87(2):215-222. doi: 10.2319/060116-438.1. Epub 2016 Sep 6. PMID: 27598906; PMCID: PMC8384369.\u003c/li\u003e\n\u003cli\u003eTavares CAE, Allgayer S (2019) Open bite in adult patients. Dental Press J Orthod 24:69\u0026ndash;78. https://doi.org/10.1590/2177-6709.24.5.069-078.bbo\u003c/li\u003e\n\u003cli\u003eWang J, Banda AK, Kau CH, Huang GJ (2024) Craniofacial management of anterior openbite: a clinical review. Front Oral Maxillofac Med 6:26. doi: 10.21037/fomm-23-3.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-archives-of-paediatric-dentistry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"EAPD","sideBox":"Learn more about [European Archives of Paediatric Dentistry](https://link.springer.com/journal/40368)","snPcode":"40368","submissionUrl":"https://submission.springernature.com/new-submission/40368/3","title":"European Archives of Paediatric Dentistry","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Fixed palatal crib, bonded spurs, Anterior open bite","lastPublishedDoi":"10.21203/rs.3.rs-6660641/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6660641/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eTo assess how fixed palatal cribs and bonded spurs affect skeletal and dentoalveolar parameters during the management of anterior open bite induced by non-nutritive sucking habits\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study was a randomised clinical trial involving 30 patients ranging from 6 to 11 years with anterior open bite\u0026thinsp;\u0026ge;\u0026thinsp;1 mm, randomly allocated into two groups: fixed palatal crib (FPC, n\u0026thinsp;=\u0026thinsp;15, mean age 8.6 years) and bonded spurs (BS, n\u0026thinsp;=\u0026thinsp;15, mean age 8.3 years). Digital biomodels and lateral cephalometric images were obtained at the beginning of the trial and 12 months post-treatment to assess the changes. Paired and independent t-tests were used for intra- and intergroup comparisons, respectively.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIntergroup analysis showed the FPC group achieved significantly greater overbite correction than the BS group (1.22\u0026thinsp;\u0026plusmn;\u0026thinsp;2.18 mm, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.00387), with 73.33% achieving a positive overbite compared to 6.67% in the BS group. The FPC group also showed significantly higher increases in mandibular arch perimeter (2.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79 mm, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.00314), maxillary arch length (1.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35 mm, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.00013), mandibular arch length (1.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30 mm, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.00001), and intermolar width (0.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24 mm, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.00001). Cephalometric findings showed greater reduction in the lower central incisor mandibular plane angle (6.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.65\u0026deg;, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.00032) and a corresponding increase in the interincisal angle (6.12\u0026thinsp;\u0026plusmn;\u0026thinsp;2.61\u0026deg;, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0. 02654), while skeletal measurements showed no statistically relevant variation between the two groups.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe fixed palatal crib appliance was more effective than bonded spurs in managing anterior open bite in growing patients, mainly via dentoalveolar changes like incisor retroclination, without affecting skeletal parameters.\u003c/p\u003e\u003ch2\u003eTrial registration\u003c/h2\u003e \u003cp\u003eThis trial was registered at clinical trial.gov, ID NCT05313399.\u003c/p\u003e","manuscriptTitle":"Comparing Skeletal and Dentoalveolar Effects of Fixed Palatal Crib and Bonded Spurs in Early Management of Anterior Open Bite Associated with Non-Nutritive Sucking Habits: A Randomised Clinical Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-19 08:57:34","doi":"10.21203/rs.3.rs-6660641/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-16T09:49:10+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-16T06:40:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-01T09:16:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"76470075120288597711047954869075053969","date":"2025-05-29T10:29:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"220908921131841848295925411929736661906","date":"2025-05-16T04:29:44+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-14T11:12:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-14T10:24:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-14T10:21:02+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Archives of Paediatric Dentistry","date":"2025-05-14T05:32:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-archives-of-paediatric-dentistry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"EAPD","sideBox":"Learn more about [European Archives of Paediatric Dentistry](https://link.springer.com/journal/40368)","snPcode":"40368","submissionUrl":"https://submission.springernature.com/new-submission/40368/3","title":"European Archives of Paediatric Dentistry","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"1ab6e57c-e5a9-4579-8588-5cb311107852","owner":[],"postedDate":"May 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-07-13T10:23:32+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-19 08:57:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6660641","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6660641","identity":"rs-6660641","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}