{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T11:06:44Z","timestamp":1769857604924,"version":"3.49.0"},"reference-count":53,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,2,28]],"date-time":"2023-02-28T00:00:00Z","timestamp":1677542400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>This study evaluates the masticatory efficiency in patients with craniofacial disorders (CD) compared to controls (C). A total of 119 participants (7\u201321 years), divided into CD group (n = 42, mean age 13.45 \u00b1 5.2 years) and C group (n = 77, mean age 14.3 \u00b1 3.27 years) under an orthodontic treatment were included. Masticatory efficiency was assessed using a standard food model test. The masticated food was examined according to its number of particles (n) and area (mm2), wherein a higher number of particles alongside a smaller area was an indication of better masticatory efficiency. Additionally, the influence of cleft formation, chewing side, dentition stage, age and sex were evaluated. Patients with CD chewed the standardized food in fewer particles (nCD = 61.76 vs. nC = 84.58), with a significantly higher amount of area than the controls (ACD = 192.91 mm2 vs. AC = 146.84 mm2; p = 0.04). In conclusion, patients with CD showed a significantly decreased mastication efficiency compared to healthy patients. Factors such as stage of cleft formation, chewing side, dentition stage and age showed an influence on masticatory efficiency, whereas no gender effect on the masticatory efficiency of CD patients was found.<\/jats:p>","DOI":"10.3390\/ijerph20054324","type":"journal-article","created":{"date-parts":[[2023,2,28]],"date-time":"2023-02-28T06:09:52Z","timestamp":1677564592000},"page":"4324","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Masticatory Efficiency in Orthodontic Patients with Craniofacial Disorder"],"prefix":"10.3390","volume":"20","author":[{"given":"Maria","family":"Schmidt","sequence":"first","affiliation":[{"name":"Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregor","family":"Slavicek","sequence":"additional","affiliation":[{"name":"Orehab Minds GmbH, Zettachring 2, 70567 Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florian","family":"Slavicek","sequence":"additional","affiliation":[{"name":"Orehab Minds GmbH, Zettachring 2, 70567 Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7641-4814","authenticated-orcid":false,"given":"Matthias C.","family":"Schulz","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9618-5016","authenticated-orcid":false,"given":"Maite","family":"Aretxabaleta","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josephine","family":"Effert","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernd","family":"Koos","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1771-0650","authenticated-orcid":false,"given":"Christina","family":"Weise","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1093\/ejo\/26.1.7","article-title":"The complex genetics of cleft lip and palate","volume":"26","author":"Cobourne","year":"2004","journal-title":"Eur. J. Orthod."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"F491","DOI":"10.1136\/archdischild-2014-306472","article-title":"Initial treatment and early weight gain of children with Robin Sequence in Germany: A prospective epidemiological study","volume":"99","author":"Maas","year":"2014","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1097\/00006534-199405000-00032","article-title":"A fall of the base of the tongue considered as a new cause of nasopharyngeal respiratory impairment: Pierre Robin sequence, a translation: 1923","volume":"93","author":"Robin","year":"1994","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1111\/j.1365-2842.2009.02040.x","article-title":"Comparing masticatory performance and mixing ability","volume":"37","author":"Mojet","year":"2010","journal-title":"J. Oral Rehabil."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"American Board of Prosthodontics, American Equilibration Society, American Prosthodontic Society, Australian Prosthodontic Society, Carl O. Boucher Prosthodontic Conference, Greater New York Academy of Prosthodontics, and Indian Prosthodontic Society (1999). The glossary of prosthodontic terms seventh edition (GPT-7). J. Prosthet. Dent., 81, 48\u2013110.","DOI":"10.1016\/S0022-3913(99)70234-9"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1111\/j.1365-2842.1996.tb00849.x","article-title":"The evaluation of masticatory function with low adhesive colour-developing chewing gum","volume":"23","author":"Matsui","year":"1996","journal-title":"J. Oral Rehabil."},{"key":"ref_7","first-page":"173","article-title":"A simple method for evaluating masticatory performance using a color-changeable chewing gum","volume":"11","author":"Hayakawa","year":"1998","journal-title":"Int. J. Prosthodont."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.jpor.2013.12.005","article-title":"Properties of a color-changeable chewing gum used to evaluate masticatory performance","volume":"58","author":"Hama","year":"2014","journal-title":"J. Prosthodont. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"271","DOI":"10.3109\/00016358309162334","article-title":"Masticatory efficiency. A new method for determination of the breakdown of masticated test material","volume":"41","author":"Gunne","year":"1983","journal-title":"Acta Odontol. Scand."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1016\/0022-3913(90)90304-U","article-title":"Masticatory efficiency determined with direct measurement of food particles masticated by subjects with natural dentitions","volume":"64","author":"Shi","year":"1990","journal-title":"J. Prosthet. Dent."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1046\/j.1365-2842.2003.01080.x","article-title":"A simplified sieve method for determining masticatory performance using hydrocolloid material","volume":"30","author":"Ohara","year":"2003","journal-title":"J. Oral Rehabil."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1177\/00220345500290040701","article-title":"Masticatory Performance and Efficiency","volume":"29","author":"Manly","year":"1950","journal-title":"J. Dent. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1046\/j.1365-2842.1999.00429.x","article-title":"Simplified method of estimating masticatory performance","volume":"26","author":"Heath","year":"1999","journal-title":"J. Oral Rehabil."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1111\/j.1365-2842.1994.tb01168.x","article-title":"Assessment of chewing efficiency: A comparison of particle size distribution determined using optical scanning and sieving of almonds","volume":"21","author":"Mowlana","year":"1994","journal-title":"J. Oral Rehabil."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1111\/j.1365-2842.1980.tb00428.x","article-title":"Masticatory efficiency","volume":"7","author":"Edlund","year":"1980","journal-title":"J. Oral Rehabil."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.jpor.2016.04.004","article-title":"Assessment of masticatory performance by means of a color-changeable chewing gum","volume":"61","author":"Tarkowska","year":"2017","journal-title":"J. Prosthodont. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1111\/j.1365-2842.1990.tb01432.x","article-title":"Comparison of food particle distribution masticated by subjects wearing complete dentures and with natural teeth","volume":"17","author":"Shi","year":"1990","journal-title":"J. Oral Rehabil."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1046\/j.1365-2842.1999.00419.x","article-title":"The influence of crossbite on the coordinated electromyographic activity of human masticatory muscles during mastication","volume":"26","author":"Ferrario","year":"1999","journal-title":"J. Oral Rehabil."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1111\/j.1365-263X.1993.tb00054.x","article-title":"Electromyographic changes resulting from orthodontic correction of Class III malocclusion","volume":"3","author":"Cavazos","year":"1993","journal-title":"Int. J. Paediatr. Dent."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.ajodo.2005.03.030","article-title":"Evaluation of the treatment changes of functional posterior crossbite in the mixed dentition","volume":"131","author":"Kecik","year":"2007","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1093\/ejo\/cjp132","article-title":"Masticatory muscle activity in children with a skeletal or dentoalveolar open bite","volume":"32","author":"Thomazinho","year":"2010","journal-title":"Eur. J. Orthod."},{"key":"ref_22","first-page":"21","article-title":"Does malocclusion affect masticatory performance?","volume":"72","author":"English","year":"2002","journal-title":"Angle Orthod."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"981","DOI":"10.2319\/011910-33.1","article-title":"The influence of malocclusion on masticatory performance. A systematic review","volume":"80","author":"Pereira","year":"2010","journal-title":"Angle Orthod."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1007\/s00784-017-2173-4","article-title":"Occlusal, chewing, and tasting characteristics associated with orofacial dysfunctions in children with unilateral cleft lip and palate: A case-control study","volume":"22","author":"Montes","year":"2018","journal-title":"Clin. Oral Investig."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1016\/j.physbeh.2018.06.037","article-title":"Development of the jaw sensorimotor control and chewing\u2014A systematic review","volume":"194","author":"Almotairy","year":"2018","journal-title":"Physiol. Behav."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1007\/s12548-009-0029-5","article-title":"A novel standard food model to analyze the individual parameters of human mastication","volume":"2","author":"Slavicek","year":"2009","journal-title":"Int. J. Stomatol. Occlusion Med."},{"key":"ref_27","first-page":"346","article-title":"Determinations and analysis of masticatory performance in unilateral cleft lip and palate","volume":"18","author":"Zhou","year":"2000","journal-title":"Hua Xi Kou Qiang Yi Xue Za Zhi"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1017\/S0007114513002699","article-title":"Anatomical, functional, physiological and behavioural aspects of the development of mastication in early childhood","volume":"111","author":"Edelson","year":"2014","journal-title":"Br. J. Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3469","DOI":"10.1152\/jn.01003.2005","article-title":"Effect of texture of plastic and elastic model foods on the parameters of mastication","volume":"95","author":"Foster","year":"2006","journal-title":"J. Neurophysiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.archoralbio.2017.07.011","article-title":"The influence of food consistency on chewing rate and muscular work","volume":"83","author":"Abbink","year":"2017","journal-title":"Arch. Oral Biol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"59","DOI":"10.4103\/2278-0203.160236","article-title":"Effect of cleft lip palate repair on craniofacial growth","volume":"4","author":"Naqvi","year":"2015","journal-title":"J. Orthod. Sci."},{"key":"ref_32","first-page":"898","article-title":"Skeletal characteristics and treatment outcome of five patients with Robin sequence","volume":"76","author":"Matsuda","year":"2006","journal-title":"Angle Orthod."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"223","DOI":"10.3109\/00016359709115421","article-title":"Craniofacial morphology in young adults with the Pierre Robin sequence and isolated cleft palate","volume":"55","author":"Laitinen","year":"1997","journal-title":"Acta Odontol. Scand."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.ajodo.2005.09.026","article-title":"Mandibular morphology and growth with and without hypodontia in subjects with Pierre Robin sequence","volume":"130","author":"Suri","year":"2006","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1016\/j.ajodo.2008.07.020","article-title":"Craniofacial morphology and adolescent facial growth in Pierre Robin sequence","volume":"137","author":"Suri","year":"2010","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1067\/mod.2001.115038","article-title":"The mandibular catch-up growth controversy in Pierre Robin sequence","volume":"120","author":"Daskalogiannakis","year":"2001","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.archoralbio.2016.03.019","article-title":"Bite force of children with repaired unilateral and bilateral cleft lip and palate","volume":"68","author":"Garcia","year":"2016","journal-title":"Arch. Oral Biol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1007\/BF02407157","article-title":"Effects of dentition status and personality on masticatory performance and food acceptability","volume":"4","author":"Garcia","year":"1989","journal-title":"Dysphagia"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e547","DOI":"10.1097\/SCS.0000000000005560","article-title":"The Electrical Activity of Masseter and Anterior Temporal Muscles in Patients with Unilateral Cleft Lip and Palate","volume":"30","author":"Jahanbin","year":"2019","journal-title":"J. Craniofac. Surg."},{"key":"ref_40","first-page":"11","article-title":"Embryology and epidemiology of cleft lip and palate","volume":"2","author":"Bernheim","year":"2006","journal-title":"B-ENT"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1111\/joor.13253","article-title":"Age and sex differences in oral functions from junior high school to young adulthood: A cross-sectional study","volume":"48","author":"Guo","year":"2021","journal-title":"J. Oral Rehabil."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Hama, Y., Hosoda, A., Kubota, C., Guo, R., Soeda, H., Yamaguchi, K., Okada, M., and Minakuchi, S. (2022). Factors related to masticatory performance in junior and senior high school students and young adults: A cross-sectional study. J. Prosthodont. Res.","DOI":"10.2186\/jpr.JPR_D_22_00137"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1111\/joor.12553","article-title":"Masticatory performance-related factors in preschool children: Establishing a method to assess masticatory performance in preschool children using colour-changeable chewing gum","volume":"44","author":"Hama","year":"2017","journal-title":"J. Oral Rehabil."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1002\/ajpa.1330500303","article-title":"On the relationship between chitin particle size and digestibility in the primate Galago senegalensis","volume":"50","author":"Kay","year":"1979","journal-title":"Am. J. Phys. Anthropol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1111\/j.1365-263X.2011.01162.x","article-title":"The effect of chewing exercise in preschool children on maximum bite force and masticatory performance","volume":"22","author":"Ohira","year":"2012","journal-title":"Int. J. Paediatr. Dent."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1044\/2017_AJSLP-16-0186","article-title":"Effects of tongue strength training on mealtime function in long-term care","volume":"26","author":"Burnett","year":"2017","journal-title":"Am. J. Speech-Lang. Pathol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1007\/s00455-017-9858-3","article-title":"Tongue-strengthening exercises in healthy older adults: Specificity of bulb position and detraining effects","volume":"33","author":"Schellen","year":"2018","journal-title":"Dysphagia"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"512","DOI":"10.5357\/koubyou.59.512","article-title":"Masticatory training with chewing gum on young children","volume":"59","author":"Ono","year":"1992","journal-title":"Kokubyo Gakkai Zasshi"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1589\/jpts.25.11","article-title":"Effect of orofacial myofunctional exercise using an oral rehabilitation tool on labial closure strength, tongue elevation strength and skin elasticity","volume":"25","author":"Ibrahim","year":"2013","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1111\/joor.12271","article-title":"Effect of the tongue rotation exercise training on the oral functions in normal adults\u2014Part 1 investigation of tongue pressure and labial closure strength","volume":"42","author":"Arakawa","year":"2015","journal-title":"J. Oral Rehabil."},{"key":"ref_51","first-page":"1034","article-title":"Effects of directional exercise on lingual strength","volume":"52","author":"Clark","year":"2009","journal-title":"JSLHR"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1159\/000071019","article-title":"Effects of two types of tongue strengthening exercises in young normals","volume":"55","author":"Lazarus","year":"2003","journal-title":"Folia Phoniatr. Logop."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1016\/j.ajodo.2015.05.029","article-title":"Association among pain, masticatory performance, and proinflammatory cytokines in crevicular fluid during orthodontic treatment","volume":"148","author":"Gameiro","year":"2015","journal-title":"Am. J. Orthod. Dentofac. Orthop."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/5\/4324\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:44:07Z","timestamp":1760121847000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/5\/4324"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,28]]},"references-count":53,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["ijerph20054324"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20054324","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,28]]}}}