Orthodontic and Craniofacial Skeletal Alterations in Individuals With Thalassemia: A Scoping Review.

BACKGROUND: Thalassemia is a well-recognized hereditary blood disorder with systemic complications. However, its craniofacial and orthodontic alterations remain incompletely characterized. Current evidence is fragmented, and no comprehensive synthesis has been published hitherto. AIMS: To map and synthesize craniofacial and orthodontic alterations in individuals with thalassemia by identifying morphological patterns and associated clinical factors. METHODS: This scoping review included cross-sectional studies, cohort studies, and clinical trials retrieved from four databases and gray literature. Data were analyzed descriptively. RESULTS: Twenty-six studies (comprising 2,353 participants) published between 1964 and 2025 were included. Common findings included a Class II skeletal pattern, mandibular retrusion, maxillary protrusion, increased lower facial height, and thalassemic facies. Orthodontic anomalies included Class II malocclusion, anterior open bite, crowding, incisor protrusion, and transverse constriction of the arches (narrow skeletal arches). Greater severity was associated with chronic anemia, splenectomy, and delayed transfusion. Only one study evaluated functional appliance therapy, demonstrating improved mandibular advancement and facial esthetics. CONCLUSION: Thalassemia is associated with clinically relevant dentoskeletal alterations that affect function and esthetics. Early orthodontic evaluation and timely interceptive treatment should be prioritized, as they may attenuate deformity progression and improve craniofacial development, reducing the future need for complex orthognathic surgery.