Luciane Macedo de Menezes

Aims: To present a conceptual and illustrative approach to the hierarchy of research study designs, emphasizing their methodological relationships and educational value as tools to support scientific literacy and methodological understanding. Methods: This conceptual and educational article was developed based on classical references in scientific methodology, evidence-based practice, and cognitive learning theories. International reporting guidelines and methodological frameworks, including CONSORT, STROBE, PRISMA, the Cochrane Handbook, and GRADE, were considered in the theoretical organization of the proposed models. Two visual representations were developed to illustrate the relationships among descriptive, observational, and interventional designs, as well as the distinction between primary and secondary studies. The figures were refined by consensus among the authors, prioritizing conceptual coherence and pedagogical applicability. Results: The proposed visual models provide an integrated perspective on research study designs, highlighting their methodological characteristics, inferential potential, and complementary roles in knowledge production. Rather than reinforcing rigid hierarchical classifications, the models emphasize functional and conceptual relationships among different study designs. By promoting cognitive organization and reducing the complexity associated with abstract methodological concepts, these representations may facilitate critical reading and improve methodological understanding among students and novice researchers. Conclusion: Contextualized visual resources and pedagogically oriented approaches may enhance the comprehension of research methodology and contribute to scientific literacy. The conceptual models presented herein offer an alternative framework for teaching study designs, fostering a more critical and integrated understanding of evidence generation in health sciences.

Background: Highly cited publications offer insight into how research influence is distributed within a field. Objectives: To identify and characterize the most highly cited orthodontic articles published between 2011 and 2020. Methods: A retrospective bibliometric analysis was conducted using citation data retrieved from the Web of Science Core Collection. Orthodontic journals indexed in the first and second quartiles (Q1 and Q2) were included. Articles were ranked by total citation counts, and due to ties at the citation threshold, 103 articles were included. Bibliometric variables examined included journal of publication, publication year, total citations, authorship structure, institutional affiliations, geographic origin, study design, and research themes. Descriptive statistics and categorical analyses were performed. Results: Citation counts ranged from 51 to 203, demonstrating a skewed distribution characteristic of citation datasets. The majority of highly cited articles were concentrated in a small subset of journals. Multi-authored publications predominated, and gender analysis revealed male predominance among authors, while geographic distribution indicated citation clustering within Europe and North America. Thematic classification identified digital technologies as the most prominent research domain. Conclusions: Gender disparities observed within authorship structures reflect broader systemic patterns documented across scientific disciplines. Technological innovation, collaborative authorship, and structural factors appear closely associated with citation visibility.

Introduction: This study evaluated the immediate skeletal and dentoalveolar effects of Minimally Invasive Surgical and Miniscrew Assisted Rapid Palatal Expansion (MISMARPE), comparing outcomes using two different appliance designs: tooth‐bone‐borne (TBB) and bone‐borne (BB) expanders. Methods: This retrospective comparative cohort study included 24 consecutively treated adult patients (mean age 35.9 ± 9.5 years): 13 in the TBB group and 11 in the BB group. Cone‐beam computed tomography scans were obtained pre‐treatment (T0) and immediately after expansion (T1) to assess skeletal and dentoalveolar changes. Generalized Estimating Equations analysis, followed by Bonferroni correction for multiple comparisons, was used to compare measurements between groups over time. Results: The MISMARPE technique produced significant increases in all linear measurements except posterior maxillary basal width in the TBB group ( p = 0.142). Both groups exhibited greater skeletal expansion in the anterior maxillary region, demonstrating a triangular expansion pattern in the axial view. The TBB group showed significantly greater increases in dental distances (6‐6CR, p = 0.002; 6‐6RT, p = 0.017) and posterior alveolar width (P‐AM, p < 0.001) compared to the BB group. No significant changes in molar inclination were observed in either group post‐expansion. Conclusions: The MISMARPE technique is effective for adult maxillary expansion, producing a triangular palatal expansion pattern in the axial view with parallel suture opening at the anterior nasal spine level in the coronal view. The TBB expander demonstrated greater transverse dentoalveolar expansion and stability of miniscrews compared to BB design, while both anchorage systems achieved similar skeletal effects.

Objective: This study evaluated, in three dimensions, the skeletal effects of two minimally invasive bone‐anchored techniques for surgically assisted palatal expansion, with and without pterygomaxillary disjunction (PD) and nasal septum disinsertion (NSD). Materials and Methods: Thirty‐nine patients were retrospectively selected from two centres and assigned to groups: G1 (without PD and NSD) and G2 (with PD and NSD). Cone‐beam computed tomography scans were analysed before and after expansion, using landmarks to assess skeletal changes along the transverse ( X ), vertical ( Y ) and anteroposterior ( Z ) planes. Results: Both groups achieved significant transverse expansion, with no intergroup difference ( p = 0.062). G1 showed significant anterior transverse asymmetry (1.4 ± 2.9 mm; p = 0.017). G2 exhibited significant inferior displacement (1.5 ± 1.6 mm right, 1.4 ± 1.5 mm left; p = 0.007, p = 0.009) and anterior displacement (0.8 ± 0.8 mm bilaterally; p = 0.005), although intergroup comparisons were not statistically significant ( p = 0.071 and p = 0.075, respectively). Both groups showed downward displacement of the apices and incisal edges of the upper central incisors, along with mild anterior movement of the posterior nasal spine and dental landmarks. Conclusion: The two techniques produced similar skeletal effects across all three‐dimensional axes. A slight clockwise rotation of the maxilla was observed, consistent with previous reports on conventional surgically assisted maxillary expansion. Anterior asymmetry was significant in G1 and may warrant further investigation. Although some displacement tendencies were observed, current evidence does not indicate a clear advantage of one technique over the other.

Objectives: To evaluate the dentoalveolar effects on the upper first premolars after two maxillary expansion protocols—rapid maxillary expansion (RME) and alternate rapid maxillary expansion and constriction (Alt‐RAMEC)—before and 6 months after treatment. Materials and Methods: Cone‐Beam Computed Tomography (CBCT) images of 20 patients who underwent maxillary expansion with the Hyrax appliance under two activation protocols were evaluated. Dental and alveolar measurements at the premolar region (tooth length, alveolar bone level and thickness) were measured before (T1) and after expansion (T2). Intra‐ and inter‐examiner reliability was determined using Intraclass Correlation Coefficients. Statistical analyses included the Shapiro–Wilk test and Student's t‐test s for paired and independent samples. Statistical significance was set at 5%. Results: A significant increase in interpremolar distances was observed, both in the radicular and coronal levels (4.29 mm and 4.97 mm), with greater coronal than root distance. This was more evident in the Alt‐RAMEC group. Alveolar thickness showed an average reduction of 0.54 mm after expansion. Conclusions: The expansion effects of the two protocols were similar in the premolar region, resulting in a reduction in alveolar thickness. A tendency for greater tooth inclination and root reduction was observed after the Alt‐RAMEC protocol. Trial Registration: IRB: 42856915.1.0000.5336

Traditionally, orthodontic-surgical treatment is performed in three stages: presurgical orthodontics, orthognathic surgery and post-surgical orthodontics. Though predictable and stable, this protocol requires a long treatment time and can temporarily compromise the patient's aesthetics. Early benefit surgery eliminates or reduces the initial stage of orthodontic treatment, providing more immediate aesthetic and functional improvement. To present a virtual diagnosis and planning protocol, combining cone beam computed tomography (CBCT) and digital models applied to early benefit surgeries using orthodontic aligners. Ten patients with dentofacial deformities underwent the proposed protocol. The accuracy of virtual planning was assessed by comparing 30 planned cephalometric measurements with those achieved postoperatively, on the "x" (transverse), "y" (anteroposterior) and "z" (vertical) axes, using anatomical reference points. Most measurements did not present statistically significant differences between planning and the surgical outcome. The exceptions were the incisive foramen on the z axis (mean difference = -1.79, P=0.045) and the left gonion on the x axis (mean difference = -1.52, P=0.029). The proposed early benefit surgery protocol with aligners proved to be a viable, safe and effective approach to conventional orthodontic-surgical treatment, with good clinical predictability rates.

Introduction: Traditionally, orthodontic-surgical treatment is performed in three stages: presurgical orthodontics, orthognathic surgery and post-surgical orthodontics. Though predictable and stable, this protocol requires a long treatment time and can temporarily compromise the patient’s aesthetics. Early benefit surgery eliminates or reduces the initial stage of orthodontic treatment, providing more immediate aesthetic and functional improvement. Objective: To present a virtual diagnosis and planning protocol, combining cone beam computed tomography (CBCT) and digital models applied to early benefit surgeries using orthodontic aligners. Method: Ten patients with dentofacial deformities underwent the proposed protocol. The accuracy of virtual planning was assessed by comparing 30 planned cephalometric measurements with those achieved postoperatively, on the “x” (transverse), “y” (anteroposterior) and “z” (vertical) axes, using anatomical reference points. Results: Most measurements did not present statistically significant differences between planning and the surgical outcome. The exceptions were the incisive foramen on the z axis (mean difference = -1.79, P=0.045) and the left gonion on the x axis (mean difference = -1.52, P=0.029). Conclusion: The proposed early benefit surgery protocol with aligners proved to be a viable, safe and effective approach to conventional orthodontic-surgical treatment, with good clinical predictability rates.