Evidence map›Paper›PMID 42226435›Full record

Observational studyClinical and experimental dental research2026

Machine Learning and Clustering Analysis of Class II and III Malocclusions.

Eva Paddenberg-Schubert, Kareem Midlej, Sebastian Krohn, Iqbal M Lone, Osayd Zohud, Obaida Awadi, Samir Masarwa, Aysar Nashef, Christian Kirschneck, Nezar Watted and 2 more

Abstract readMulticenter StudyObservational Study
In one paragraph

Observational study in Clinical and experimental dental research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Eva Paddenberg-SchubertDepartment of Orthodontics, University Hospital of Regensburg, University of Regensburg, Regensburg, Germany.
Kareem MidlejDepartment of Clinical Microbiology and Immunology, Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
Sebastian KrohnDepartment of Orthodontics, University Hospital of Regensburg, University of Regensburg, Regensburg, Germany.
Iqbal M LoneDepartment of Clinical Microbiology and Immunology, Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
Osayd ZohudDepartment of Clinical Microbiology and Immunology, Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
Obaida AwadiCenter for Dentistry Research and Aesthetics, Jatt, Israel.
Samir MasarwaCenter for Dentistry Research and Aesthetics, Jatt, Israel.
Aysar NashefDepartment of Oral and Maxillofacial Surgery, Meir Medical Center, Kfar Saba, Israel.
Christian KirschneckDepartment of Orthodontics, University of Bonn, Bonn, Germany.
Nezar WattedCenter for Dentistry Research and Aesthetics, Jatt, Israel.
Peter ProffDepartment of Orthodontics, University Hospital of Regensburg, University of Regensburg, Regensburg, Germany.
Fuad A IraqiDepartment of Orthodontics, University Hospital of Regensburg, University of Regensburg, Regensburg, Germany.ORCID 0000-0001-5525-206X

Funding

Orthodontic Research CenterTel Aviv UniversityUniversity Hospital of Regensburg
6 · The paper itself

Abstract

objectivesThis prospective observational study aims to accurately classify individuals as skeletal class II/III by applying several machine-learning algorithms. Furthermore, using the k-means clustering analysis deepened our understanding of the characteristics of skeletal class II/III malocclusion (SCIIMO/SCIIIMO) patients. MATERIALS AND

methodsThis multicenter study consisted of 379 German orthodontic patients. Following their distribution to SCIIMO (n = 208, 54.8%) or SCIIIMO (n = 171, 45.1%) by the individualized ANB of Panagiotidis and Witt. Machine-learning analysis was performed using different models (KNN, RF, LDA, SVM, CART) to find the model with the highest accuracy in correctly classifying skeletal class II/III. After determining the ideal number of clusters using the Elbow approach, k-means clustering was finally used.

resultsThe KNN machine learning model demonstrated the ability of reduced cephalometric parameters to capture much of the same sagittal discriminatory information as the predefined class construct. The results showed that Wits-appraisal only leads to achieving high accuracy in determining skeletal class (accuracy = 94.72%), while adding SN-Pg angle improved the accuracy slightly to 95.86%. The clustering analysis showed that three or four clusters were optimal for SCIIMO and SCIIIMO patients and revealed interesting characteristics for each cluster and significance between the differences in all parameters except S-N and age.

conclusionsA reduced parameter set that included only the Wits appraisal and SN-Pg angle enabled a correct classification. In the exploratory clustering analysis, three or four distinct clusters emerged as optimal when analyzing the differences among SCIIMO/SCIIIMO patients, emphasizing the complexity and diversity of malocclusion phenotype.

Indexed as

Machine LearningMalocclusion, Angle Class IIMalocclusion, Angle Class IIIAdolescentCephalometryChildClassification AlgorithmsCluster AnalysisClustering AlgorithmsFemaleHumansMalePrediction AlgorithmsPredictive Learning ModelsProspective Studiescongenitalhereditarymalocclusion classificationneonatal diseasespopulation characteristicsstomatognathic diseasesstomatognathic system

Identifiers

PMID42226435
PMCPMC13239717

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.