Craniofacial dimensions and malocclusions in children and adolescents with a high body mass index: a systematic review and meta-analysis
Bibliographic record
Abstract
BACKGROUND: Obesity and overweight represent significant public health concerns affecting children and adolescents. Besides their association with accelerated pubertal growth, the high body mass index (BMI) has been implicated in craniofacial dimension alterations and malocclusion development within this age group. OBJECTIVE: This study aimed to evaluate the impact of high BMI on sagittal and vertical craniofacial dimensions and malocclusions in children and adolescents. Search methods: We conducted unrestricted electronic searches across nine databases until November 2024. Selection criteria: Inclusion criteria were cross-sectional, case-control, and cohort studies involving participants aged 5 to 19 years that established a relationship between BMI, dimensional changes in craniofacial structures, and the presence of malocclusion. The research question applied the PECO framework. Data collection and analysis: After removing duplicates, extracting the data, and assessing the risk of bias with the JBI Critical Appraisal Tools for observational studies, we performed random-effects meta-analyzes of mean differences (MD) with 95% confidence intervals (CI). Subsequently, we assessed the quality of evidence. RESULTS: The study included 21 articles (19 cross-sectional, one cohort, one case-control) with low-to-moderate risk of bias. Eight studies focused on craniofacial dimensions, and 13 on malocclusion. The meta-analysis revealed significantly larger sagittal dimensions in patients with obesity or overweight, including extended cranial base length (S-N, MD = 0.8452 [0.5531-1.1373]), mandibular length (Cd-Gn, MD = 0.5770 [0.0639-1.0902]), maxillary length (Cd-A, MD = 0.8021 [0.4251-1.1790]), and bimaxillary protrusion (SNA, MD = 0.6008 [0.1099-1.0916]; SNB, MD = 0.6712 [0.1328-1.2096]; SNPg, MD = 0.5921 [0.0666-1.1175]). Concurrent gains in posterior facial height (S-Go, MD = 0.6619 [0.2385; 1.0853]) in the vertical dimension usually did not alter the overall facial plane, tending towards more horizontal growth. These gains were higher for girls with high BMI. Regarding malocclusions, only two of the 13 studies identified statistically significant associations between dental crowding and high BMI. While seven studies exhibited a low risk of bias, the included articles commonly demonstrated limited control over potential confounders. CONCLUSION: Based on limited evidence, children and adolescents with high BMI presented enhanced bimaxillary prognathism and enlarged sagittal and vertical craniofacial dimensions. The BMI did not consistently impact malocclusions, although a few studies linked dental crowding to overweight. Orthodontic planning for this population should consider the patient's BMI. REGISTRATION: PROSPERO (CRD 42024511194).
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".