To investigate the three- dimensional morphological characteristics of the upper airway in children and adolescents with skeletal class Ⅲ malformation and to explore the relationship between craniofacial structure and upper airway morphology.

Ninety cases of malocclusion aged 3-18 years were collected. In addition, 45 cases of type Ⅰ and type Ⅲ were classified into three age groups with 15 cases in each group: 3-6 years old, 7-12 years old and 13-18 years old. CBCT was taken, and the scanning data of CBCT were reconstructed by the third-party software Invivo 5. The volume, minimum cross-sectional area, height and the ratio of sagittal diameter to transverse diameter at the minimum cross-sectional area of each segment of the upper airway were measured. The difference of the upper airway between skeletal class Ⅰ and skeletal class Ⅲ in each age group was analyzed and compared by group t test.

No significant differences in the upper airway indexes were noted between skeletal class Ⅰ and skeletal class Ⅲ(P > 0.05) in the 3-6 years old group. In the 7-12 years old group, the total volume of skeletal class Ⅲ upper airway (16.25 ± 3.69 cm³), nasopharyngeal segment (2.39 ± 0.90 cm³), and palatopharyngeal segment (5.24 ± 1.14 cm³) were reduced compared with the total volume of the skeletal class Ⅰ upper airway (20.98 ± 6.25 cm³) , nasopharyngeal segment (4.21 ± 1.09 cm³), and palatopharyngeal segment (8.18 ± 2.02 cm³), respectively, the differences were statistically significant (t_Vtotal＝2.526, t_Vnose＝4.999, t_Vpalate＝4.908, P < 0.05). In the 13-18 years old group, only nasopharyngeal segment volume (3.83 ± 0.90 cm³) was reduced in skeletal type Ⅰ (4.69 ± 1.34 cm³); the difference was statistically significant (t＝2.053, P < 0.05).

Age is an important factor affecting the morphology and structure of upper airway in skeletal Ⅲ malocclusion.

To investigate the dynamic changes in oral health-related quality of life (OHRQoL) and self-esteem (SE) across different stages of adolescent orthodontic treatment and the influence of psychosocial factors, thereby providing scientific evidence for the clinical development of individualized treatment protocols that integrate both functional correction and psychological intervention.

This study was reviewed and approved by the medical ethics committee, and informed consent was obtained from patients. A cross-sectional design was employed to randomly select 355 adolescent patients with malocclusion (133 pre-treatment, 112 during treatment, and 110 post-treatment) who received care at the Department of Stomatology, Renmin Hospital of Wuhan University in April 2025. The Oral Health Impact Profile (OHIP)-14 was used to assess OHRQoL levels, the Global Self-Esteem Scale (GSE) was used to evaluate SE levels, and an additional questionnaire on dental appearance-related psychosocial aspects was administered. Kruskal-Wallis tests were used to compare differences between treatment stage groups, followed by Dunn post hoc tests. Spearman correlation analysis was employed to assess the associations between variables, including orthodontic treatment stages, OHRQoL, and SE, as well as SE and dental appearance-related psychosocial aspects.

OHRQoL and its four dimensional scores showed significant differences across different stages of orthodontic treatment. Specifically, the total OHIP-14 score showed no significant difference between pre-treatment and during treatment [12.0 (7.0, 18.0) vs. 13.0 (9.0, 17.0)], but significantly decreased to 4.0 (0.8, 11.0) post-treatment (P<0.001). The total scores for physical pain and discomfort dimension and physical disability dimension demonstrated a pattern of during treatment > pre-treatment > post-treatment (P<0.05). The total scores for handicap dimension showed no significant difference between pre-treatment and during treatment, but post-treatment scores were significantly lower than both pre-treatment and during treatment levels (P < 0.001). The total scores for psychological discomfort dimension showed a significant decreasing trend across treatment stages (P<0.001). The total GSE score showed significant differences only between pre-treatment and during treatment [18.0 (12.0, 23.0) vs. 13.5 (9.3, 20.8), P=0.014], with recovery to 14.0 (12.0, 18.0) post-treatment. Different treatment stages showed a moderate negative correlation with total OHIP-14 score (r=-0.362, P<0.001) and a weak negative correlation with total GSE score (r=-0.104, P=0.049). The appearance satisfaction index showed a significant increasing trend across treatment stages (P<0.001), while being teased about teeth and hiding teeth and avoiding smiling index significantly decreased (both P<0.001). Being teased about teeth index (r=0.349, P<0.001) and hiding teeth and avoiding smiling index (r=0.412, P<0.001) were significantly correlated with total GSE score.

Adolescents undergoing orthodontic treatment experience a significant improvement in quality of life, with self-esteem levels notably increasing during the mid-treatment phase and a continuous reduction in negative psychosocial experiences related to dental appearance. This suggests that orthodontists should prioritize psychological support and social adaptation guidance throughout the treatment process, with consistent attention to changes in patients’ self-esteem.