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ORIGINAL ARTICLE • Dental Press J. Orthod. 31 (3) • 2026 • https://doi.org/10.1590/2177-6709.31.3.e2625242.oar linkcopy

Open-access The 100 most cited articles on malocclusion’s biopsychosocial impact in school-aged youth: bibliometric study

AuthorshipSCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:  This study assessed the characteristics of the 100 most-cited papers on the biopsychosocial impact of malocclusion in school-aged youth.

Methods:  The Web of Science Core Collection (WoS-CC) database was searched. Data extracted included title of the paper, year of publication, authorship, number of citations, institution, country, continent, study design, journal and its impact factor, and keywords. A content analysis was performed to extract information on malocclusion diagnosis indices, age group, sample size, biopsychosocial outcomes, and assessment instruments. Bibliometric networks were created using VOSviewer and Power BI software. Descriptive analyses and Poisson regression were conducted (p < 0.05).

Results:  The 100 most-cited articles were selected from the 1,297 studies, totaling 3,621 citations. Most of the studies were cross-sectional (n=89), with a majority originating from Brazil (n=54). The Angle Orthodontist and the American Journal of Orthodontics and Dentofacial Orthopedics stood out with the highest number of publications and citations (11 articles, 532 and 461 citations, respectively). The authors with the most citations was C.A. Feldens, being the most cited author (n = 256). “Malocclusion” was the most used keyword (n = 39). The most prolific institutions were Universidade Federal de Minas Gerais (12 articles), Universidade Estadual de Campinas (11 articles), and Universidade Federal de Santa Maria (8 articles).

Conclusion:  Cross-sectional studies conducted by Brazilian authors examining the impact of malocclusion on oral health-related quality of life predominated. More diverse study designs, broader geographic representation, and longitudinal approaches are necessary to strengthen the evidence on the biopsychosocial effects of malocclusion.

Keywords:
Adolescent; Bibliometrics; Child; Malocclusion; Models, biopsychosocial

RESUMO

Introdução:  Este estudo avaliou as características dos 100 artigos mais citados sobre o impacto biopsicossocial da má oclusão em crianças e adolescentes em idade escolar.

Métodos:  A base de dados Web of Science Core Collection (WoS-CC) foi pesquisada. Os dados extraídos incluíram título do artigo, ano de publicação, autoria, número de citações, instituição, país, continente, delineamento do estudo, periódico e seu fator de impacto, além de palavras-chave. Foi realizada análise de conteúdo para extrair informações sobre índices diagnósticos de má oclusão, faixa etária, tamanho amostral, desfechos biopsicossociais e instrumentos de avaliação. Redes bibliométricas foram criadas utilizando os softwares VOSviewer e Power BI. Foram realizadas análises descritivas e regressão de Poisson (p < 0,05).

Resultados:  Os 100 artigos mais citados foram selecionados entre 1.297 estudos, totalizando 3.621 citações. A maioria dos estudos foi transversal (n = 89), com predominância do Brasil (n = 54). The Angle Orthodontist e o American Journal of Orthodontics and Dentofacial Orthopedics destacaram-se com o maior número de publicações e citações (11 artigos, 532 e 461 citações, respectivamente). O autor com maior número de citações foi C.A. Feldens (n = 256). “Malocclusion” foi a palavra-chave mais utilizada (n = 39). As instituições mais produtivas foram Universidade Federal de Minas Gerais (12 artigos), Universidade Estadual de Campinas (11 artigos) e Universidade Federal de Santa Maria (8 artigos).

Conclusão:  Predominaram estudos transversais conduzidos por autores brasileiros examinando o impacto da má oclusão na qualidade de vida relacionada à saúde bucal. São necessários delineamentos mais diversos, maior representatividade geográfica e abordagens longitudinais para fortalecer as evidências sobre os efeitos biopsicossociais da má oclusão.

Palavras-chave:
Adolescente; Bibliometria; Criança; Má oclusão; Modelos biopsicossociais

INTRODUCTION

The biopsychosocial model conceptualizes health as an interaction between biological, psychological, and social dimensions, extending beyond a purely biomedical perspective.1 In Dentistry, this approach emphasizes patient-centered care and considers subjective experiences and social contexts affecting oral health outcomes.2,3 By integrating clinical, psychosocial and environmental factors, it provides a comprehensive framework for understanding the broader impacts of oral disorders.4

Malocclusion should not be considered solely a morphological issue but as a condition influencing multiple aspects of well-being, particularly during childhood and adolescence.5-8 Oral health is essential for functions like speaking, chewing, and swallowing, as well as psychological, emotional, and social well-being.9 Conditions such as malocclusion may cause functional and esthetic issues,5 impair oral health-related quality of life,6 reduce self-esteem due to embarrassment when smiling and speaking,7 and contribute to bullying during school age, when appearance and social interaction are critical to emotional and social development.8,10

The global prevalence of malocclusion in children and adolescents is 56%, with no significant sex differences.11 Regarding the epidemiological distribution among continents, the highest prevalence occurs in African countries (58%), followed by Europe (71%), the Americas (53%), and Asia (48%), with no data for Oceania.11 In Brazil, anterior open bite and posterior crossbite occur more frequently than in other regions.12

Systematic reviews and meta-analyses critically synthesize evidence to answer clinical questions.13 Bibliometric analyses, in contrast, examine scientific production, identifying patterns, trends, collaboration networks, and theoretical influences.14 Recognizing the most cited articles in dentistry helps guide research, education, and services.15

Understanding bibliometric indices related to the biopsychosocial impact of malocclusion allows researchers to map the current state of research and informs new studies aimed at improving quality of life, self-esteem, and reducing school-related psychosocial problems. This study analyzed the characteristics of the 100 most cited articles on the biopsychosocial impact of malocclusion on children and adolescents in the school environment.

METHODS

This bibliometric review followed the guideline for reporting bibliometric reviews of the biomedical literature (BIBLIO).16

INFORMATION SOURCES

The electronic search was conducted in the Web of Science Core Collection (WoS-CC) due to its broad interdisciplinary coverage and comprehensive metadata, which are well suited for bibliometric analyses. The use of a single database was intended to minimize the risk of duplicate records and reduce potential human error during data extraction and screening.

SEARCH STRATEGY AND TIME PERIOD

Two independent examiners conducted a comprehensive search in the WoS-CC database in March 2025, using the following strategy: “Malocclusion” OR “Malocclusions” OR “Dental Malocclusion” (All Fields) AND “Models, Biopsychosocial” OR “Biopsychosocial Model” OR “Bullying” OR “Absenteeism” OR “Academic Achievement” OR “Academic Performance” OR “School Performance” OR “Educational Measurement” OR “Educational Test Score” OR “School Dropout” OR “Quality of Life” OR “Oral Health Related Quality of Life” OR “Self Concept” OR “Self Image” OR “Self Perception” OR “Self Esteem” OR “Emotional Intelligence” OR “Personal Satisfaction” (All Fields). No filters were applied during the search, and there were no restrictions for publication language or year.

ELIGIBILITY CRITERIA AND DATA REFINEMENT

The identified results were organized in descending order of citations based on the data from the WoS-CC database. Two independent and previously calibrated reviewers (M.B.O. and D.C.F.) selected the articles by analyzing titles and abstracts, followed by the full texts. The inclusion criteria were articles on the biopsychosocial impact of malocclusion on school-aged children and adolescents. For the purposes of this bibliometric analysis, school-aged children and adolescents were defined as individuals enrolled in primary or secondary education, typically aged between 6 and 18 years. Editorials, conference papers, comments and letters to the editor, studies with preschool children and adults, questionnaire validations, research outside the school environment, and studies with children and/or adolescents wearing orthodontic appliances during the investigation were excluded. The articles meeting all eligibility criteria were included, and if the reviewers disagreed, a third party (L.R.P.) was consulted to resolve the conflict.

After selecting the 100 most cited articles, .txt and Excel files were exported from the WoS-CC database. The following information was extracted from each article: title, year of publication, authorship, number of citations, citation mean per year (calculated as the total number of citations divided by the number of years since publication until 2025), research center or affiliated institution/university, country and continent, study design, journal name, Journal Citation Reports Impact Factor (JCR® IF 2024), and keywords. Two reviewers (M.B.O. and D.C.F.) independently evaluated the data to minimize errors. Country and continent information was determined based on the corresponding author’s affiliation. Study designs were classified as cross-sectional, case-control, and longitudinal.

FULL-TEXT REVIEW AND CONTENT ANALYSIS

A full-text review and a content analysis were conducted to extract methodological and thematic information from the selected articles. The selected articles were fully analyzed to identify information about study sample, age group, sample size, malocclusion diagnosis indices, biopsychosocial outcomes, assessment instruments, and impact of malocclusion. Biopsychosocial outcomes were operationally classified into psychological and social domains. Psychological outcomes included oral health-related quality of life (OHRQoL), self-esteem, self-concept, self-image, emotional well-being, and personal satisfaction. Social outcomes comprised bullying experiences, peer relationships, social interaction difficulties, school absenteeism, and perceived social impact related to dental appearance.

QUALITY ASSESSMENT

No formal methodological quality assessment was conducted, as this procedure is not applicable to the scope of the present study, in which the primary selection criterion was the impact of the articles in the scientific literature, measured by citation counts.

DATA ANALYSIS AND VISUALIZATION

A graphical bibliometric network was generated using the Visualization of Similarities Viewer software (VOSviewer, version 1.6.17.0, Netherlands). The relationships between authors, institutions, and keywords were organized in clusters. The words linked to larger clusters and sources were more frequent, while those associated with smaller clusters and sources were less recurrent. The connections among clusters were represented by lines, portraying their interactions. Power BI (Microsoft, Redmond, Washington, USA) software was used to explore the relationship of the top 10 most cited regarding authorship, keywords, affiliations, and journal. The MapChart tool (https://mapchart.net/) illustrated the global distribution of the selected articles.

STATISTICAL ANALYSIS

A Poisson regression examined the association between the total number of citations from the articles and the independent variables. The articles were categorized according to the origin continent of the corresponding author (Africa, Asia, Europe, Oceania, North America, and South America), publication period (1996-2015 and 2016-2024), sample size (higher or lower than 597), and journal’s impact factor (higher or lower than 2.7) by the classification of the JCR® IF 2024. The cutoff point for the sample size and impact factor variables was based on the median of all included studies. The analysis used R software for Windows, version 4.3.3. The findings were reported as rate ratios (RR) and respective confidence intervals (CI) at a 5% significance level (p < 0.05).

RESULTS

A total of 1,297 records were identified and ranked in descending order of citation counts based on the WoS-CC database. After screening titles and abstracts, 1,146 articles were excluded for not meeting the eligibility criteria. A total of 151 articles underwent full-text review, with the 100 most-cited papers ultimately included in the study. Table 1 presents these articles ranked by citation count.

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Table 1:
Top 100 most-cited papers on the biopsychosocial impact of malocclusion in school-aged children and adolescents.

The 100 most-cited articles accumulated a total of 3,621 citations, ranging from 517,18 to 14819,20 per article, with a mean of 36.21 citations. Six studies received more than 100 citations19-24 (Table 1). A total of 36 journals were represented. The Angle Orthodontist and the American Journal of Orthodontics and Dentofacial Orthopedics had the highest number of publications and citations (11 articles, 532 and 461 citations, respectively), followed by the European Journal of Orthodontics (7 articles, 374 citations) and Community Dentistry and Oral Epidemiology (5 articles, 287 citations) (Table 1).

The earliest article was published in 1996 (77 citations, average 2.57 citations per year), and the most recent in 2024 (5 citations, average 2.5 citations per year) (Table 1, Fig. 1). Most publications occurred between 2015 and 2019 (37 articles), with 2017 showing the highest number of publications (n = 10). Citation peaks occurred between 2010 and 2014 (n = 1,196), with 2013 contributing 395 citations (Fig. 1).

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Figure 1:
Annual distribution of publications and citations among the 100 most-cited articles.

Co-authorship analysis identified 363 authors across 60 clusters, five of which exhibited strong connections, comprising 36 authors (Fig. 2A-B). The most prolific authors were S.M. Paiva (9 articles, 499 citations), T.M. Ardenghi (8 articles, 270 citations), M.C. Meneghim (8 articles, 147 citations), S.A.S. Vedovello (8 articles, 144 citations), and C.A. Feldens (6 articles, 258 citations), with S.M. Paiva having the highest total citations.

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Figure 2:
Co-authorship networks among the top 100 articles. A) Density map displaying 60 author clusters. Red indicates stronger total link strength between authors, whereas blue indicates weaker link strength. B) Overlay visualization highlighting the main clusters among the included studies. The scale bar represents average citation counts.

A total of 121 organizations were identified, with 51 meeting the analysis threshold (Fig. 3A). The Federal University of Minas Gerais (12 articles, 514 citations), the State University of Campinas (11 articles, 328 citations), and the Federal University of Santa Maria (8 articles, 304 citations) were the most productive institutions. Among the top 10 most-cited articles, the Federal University of Juiz de Fora and the State University of Campinas were most frequently represented across authors and Keywords Plus (14% each) (Fig. 3B).

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Figure 3:
A) Institutional affiliations of contributing authors (institutions with ≥40 citations included). B) Sankey plot illustrating correlations among authors, affiliations, and Keywords Plus. Co-occurrence network of keywords appearing two or more times in the 50 most cited articles over time.

Corresponding authors came from 23 countries. Brazil led with 50 publications (1,830 citations), followed by the United Kingdom (8 articles, 370 citations), Jordan (4 articles, 221 citations), India (4 articles, 125 citations), Nigeria (4 articles, 66 citations), and Lithuania (4 articles, 40 citations). All continents contributed, with the Americas having the highest output (57 articles, 2,081 citations) (Fig. 4).

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Figure 4:
Global distribution of the 100 most-cited articles on the biopsychosocial impact of malocclusion in school-aged children and adolescents.

Among the 100 most-cited articles, cross-sectional studies predominated (n = 89), accounting for 3,300 citations (Fig. 5). Author-defined keywords with more than two occurrences are presented in Figure 6. Of 121 keywords identified, 40 met the threshold. The most frequent were “malocclusion” (n = 39), “quality of life” (n = 28), “oral health-related quality of life” (n = 20), “oral health” (n = 19), and “adolescents” (n = 12). As a Keywords Plus term, “malocclusion” had the highest citation count among the top 10 most-cited articles across universities (8%), followed by “children” (7%) and “orthodontic treatment need” (6%) (Fig. 3B).

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Figure 5:
Distribution of studies by design. Blue bars indicate the number of publications per design, red bars the total number of citations, and the green line represents the citation-to-publication ratio (citations per paper). A logarithmic scale was applied to the Y-axis

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Figure 6:
Keyword co-occurrence over time. Visualization of keywords appearing at least twice among the top 100 most-cited articles.

Table 2 summarizes the content analysis of the 100 most-cited articles on the biopsychosocial impact of malocclusion in school-aged children and adolescents. Brazilian school-aged youth were the predominant sample (54 publications), with the 11-14-year age range most frequently studied (17 studies). The Dental Aesthetic Index (DAI) was the most frequently used tool for malocclusion assessment, followed by other recognized indices such as the Index of Orthodontic Treatment Need (IOTN). Psychological outcomes were the most frequently reported and included oral health-related quality of life (OHRQoL), self-esteem, self-image, self-concept, emotional well-being, and personal satisfaction. OHRQoL was predominantly assessed using the Child Perceptions Questionnaire (CPQ), with other validated instruments, including the Oral Aesthetic Subjective Impact Scale (OASIS) (Table 2).

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Table 2:
Summary of the content analysis of the 100 most-cited papers on the biopsychosocial impact of malocclusion in school-aged children and adolescents.

Overall, reviewed studies indicated that malocclusion severity is associated with poorer OHRQoL, particularly in emotional and social domains. Traits such as increased overjet, diastemas, anterior crowding, and posterior crossbite were most frequently linked to higher aesthetic concern, bullying experiences, and greater demand for orthodontic treatment. Adolescents’ self-perception, expressed as dissatisfaction with dental appearance and lower self-esteem, was as influential as or even more than normative need in determining psychosocial impact (Table 2).

Poisson regression analysis (Table 3) revealed that sample size and publication year were significantly associated with citation counts. Studies with larger samples (>597) received fewer citations than smaller studies (adjusted RR = 0.73; 95% CI: 0.55-0.97; p = 0.033). Similarly, recent publications (2016-2024) were cited less than older ones (1996-2015; adjusted RR = 0.47; 95% CI: 0.34-0.64; p < 0.001). No significant associations were found for continent of origin or journal impact factor after adjustment.

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Table 3:
Poisson regression analysis between the independent variables and the number of article citations in Web of Science.

DISCUSSION

This study represents the first comprehensive bibliometric analysis of the 100 most-cited articles on the biopsychosocial impact of malocclusion in school-aged children and adolescents, mapping trends, key contributors, and thematic focuses. The included articles accumulated 3,621 citations, with cross-sectional studies predominating (n = 89), indicating a strong reliance on observational designs. Brazilian authors and institutions were prominently represented, with the Universidade Federal de Minas Gerais, Universidade Estadual de Campinas, and Universidade Federal de Santa Maria among the most productive institutions. Brazil led in both publication and citation counts, followed by the United Kingdom and Jordan, reflecting a concentration of research output in specific geographic regions.

The number of citations per article ranged from 5 to 148, with a mean of 36.21. These figures differ from those reported in a bibliometric analysis of the 100 most-cited articles on OHRQoL, in which the top-cited study received 949 citations in the Web of Science Core Collection database.15 This discrepancy may be attributed to differences in study objectives and eligibility criteria. As in the present review, cross-sectional studies were also the most prevalent design in that analysis.15

A total of 36 journals were represented in this analysis, and no significant association was observed between journal impact factor and citation counts after adjustment. In this sample, open-access availability was more frequent among journals with lower impact factors (≤ 2.7), which may partially explain the lack of association between impact factor and citations and underscores the role of accessibility in enhancing research visibility.

Additionally, the regression analysis indicated that larger sample size and more recent publication year were associated with lower citation counts. This pattern appears to be primarily explained by the historical timing of publication rather than by sample size itself. Citation accumulation in this field peaked between 2010 and 2014, particularly in 2013, a period marked by studies that established key conceptual and methodological frameworks for assessing the biopsychosocial impact of malocclusion. In contrast, most large-sample studies were published after 2015, placing them outside this period of highest citation density and limiting their opportunity for citation accrual. These findings suggest that citation impact is strongly shaped by publication timing and the developmental stage of the research field, rather than by methodological scale alone.

Citations, defined as references to prior studies acknowledging the origin of methods, ideas, and findings, are commonly used as an approximate indicator of scientific relevance.116 However, citation counts do not necessarily reflect the immediate impact of a publication, as they are strongly influenced by the interval between publication and recognition within the scientific community. Older articles tend to accumulate more citations due to longer exposure and progressive incorporation into subsequent research. In addition, the time required for the preparation, submission, and publication of citing articles directly affects citation accumulation. Previous studies indicate that citation frequency typically peaks within two to three years after publication, followed by a gradual decline, a phenomenon often described as “attention decay”.117,118 Accordingly, citation counts should be interpreted in light of exposure time and the dynamic process of scientific dissemination.

The journals with the highest number of publications and citations were The Angle Orthodontist and the American Journal of Orthodontics and Dentofacial Orthopedics, both specialized in orthodontics, with impact factors of 3.2 and 3.0, respectively, according to JCR® IF 2024. Although the impact factor is commonly used as an indicator to estimate a journal’s relative importance,119 analyses in this study showed that it did not have a statistically significant effect on the number of citations, indicating that articles published in journals with higher impact factors were not necessarily cited more frequently. Although Brazil leads in the number of published articles on the topic, none of the five studies published in the International Journal of Environmental Research and Public Health, which had the highest impact factor in this analysis (4.614), were authored by Brazilian researchers.

Of the 100 articles included in this bibliometric review, 89 used a cross-sectional design. This approach is favored for its lower cost, standardized and precise data collection, ability to estimate disease prevalence, control for confounding factors, and assess multiple outcomes within the same population.120 The school setting offers additional advantages by reducing selection bias associated with seeking dental care and providing access to a larger, more diverse sample of children and adolescents, enhancing representativeness and external validity. Nevertheless, cross-sectional designs are limited by the lack of temporal information, which restricts causal inference.120

The prominence of Brazilian authors and institutions in this bibliometric review highlights the strategic relevance of local research centers in promoting academic visibility. Universities such as the Federal University of Minas Gerais and the Federal University of Santa Maria act as central nodes in collaborative networks, supporting national leadership in the field. Scientific collaboration not only enhances productivity but also increases citation impact, as collaborative teams are more likely to produce influential work.121-124 The country’s prominent role in Latin American dental research also reflects a broader reconfiguration of the global geography of science, in which emerging economies are assuming an increasingly central role.125,126 This scenario reinforces the need for sustained investment in public research infrastructure and collaborative capacity to ensure long-term international scientific relevance.

At the same time, the concentration of publications in a limited number of countries may indicate a regional publication bias and draws attention to persistent global inequalities in scientific production. The underrepresentation of regions such as Africa and Oceania constrains the extrapolation of findings to diverse sociocultural contexts, where perceptions of dental aesthetics, social norms, access to orthodontic care, and school environments may differ substantially. Consequently, the generalizability of the biopsychosocial impacts of malocclusion identified in this review should be interpreted with caution, reinforcing the need for broader geographic representation and international collaboration in future research.

Content analysis demonstrated that malocclusion, predominantly assessed using the Dental Aesthetic Index (DAI), was consistently associated with poorer oral health-related quality of life (OHRQoL), particularly affecting the emotional, social, and physical domains. Studies showed that greater malocclusion severity measured by the DAI was associated with higher CPQ scores and worse emotional and social well-being among schoolchildren.5,31,32 Specific occlusal traits, including increased overjet, diastemas, and anterior crowding, were related to negative aesthetic self-perception and dissatisfaction with dental appearance.39,62 In addition, severe malocclusion was identified as a relevant factor associated with bullying experiences and increased demand for orthodontic treatment.79

A systematic review and meta-analysis investigating the impact of untreated malocclusion on OHRQoL showed that greater malocclusion severity is significantly associated with increased negative effects, especially in physical and psychosocial domains.127 Studies using the DAI, Index of Orthodontic Treatment Need (IOTN), or Index of Complexity, Outcome and Need (ICON) to assess malocclusion, together with the Oral Health Impact Profile (OHIP) to measure OHRQoL, indicated that more severe malocclusion corresponds to higher impact scores in physical limitations, pain, psychological discomfort, and social and psychological disability.127 Early prevention and treatment, including interceptive interventions, orthodontic follow-up, and oral health education, allow prioritization of high-impact cases, mitigate psychosocial consequences, and improve OHRQoL.

This study has some limitations. The exclusive use of the Web of Science Core Collection represents a methodological constraint, as relevant studies indexed in other databases, such as Scopus or Google Schoolar, may not have been captured. However, WoS-CC is widely recognized for its rigorous indexing criteria and standardized citation metrics, making it particularly suitable for bibliometric analyses focused on citation impact and network mapping. Additionally, the focus on the 100 most-cited articles may have excluded relevant emerging research that has not yet accumulated a high citation count.

Nevertheless, this analysis provides a comprehensive overview of influential trends in the field, offering valuable insights for researchers, oral health professionals, and policymakers seeking to integrate biopsychosocial perspectives into malocclusion prevention and intervention strategies. Future research should explore additional dimensions, including self-esteem, academic performance, and social relationships, incorporate underrepresented regions, and prioritize longitudinal and cohort designs to overcome the inherent limitations of cross-sectional studies and establish more robust causal relationships between malocclusion and biopsychosocial outcomes.

CONCLUSIONS

This bibliometric analysis demonstrates that research on the biopsychosocial impact of malocclusion in school-aged children and adolescents is predominantly based on cross-sectional designs and emphasizes patient-reported outcomes, particularly oral health-related quality of life. The most influential studies consistently indicate that greater malocclusion severity is associated with adverse emotional, social, and psychological outcomes, including dissatisfaction with dental appearance, reduced self-esteem, and bullying experiences, underscoring the relevance of subjective perceptions alongside normative treatment need. The prominent contribution of Brazilian institutions highlights their central role in knowledge production, while the geographic concentration of highly cited studies indicates limited global representativeness. Overall, these findings reinforce the relevance of biopsychosocial frameworks in orthodontic research and practice and point to the need for longitudinal investigations to better inform preventive and therapeutic strategies aimed at reducing the psychosocial burden of malocclusion during childhood and adolescence.

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  • How to cite:
    Oliveira MB, Terada ASSD, Ferraz DC, Toniollo MB, Vieira WA, Paiva SM, Lima RR, Paranhos LR. The 100 most cited articles on malocclusion’s biopsychosocial impact in school-aged youth: bibliometric study. Dental Press J Orthod. 2026;31(3):e2625242.
  • » Data Availability Statement:
    Due to the sensitive nature of the data and ethical restrictions, the datasets supporting this study are not publicly available.

Edited by

  • Editor-in-Chief:
    Matheus Melo Pithon / Associate Editor: Claudia Mattos

Data availability

Due to the sensitive nature of the data and ethical restrictions, the datasets supporting this study are not publicly available.

Publication Dates

  • Publication in this collection
    28 Aug 2026
  • Date of issue
    2026

History

  • Received
    19 Sept 2025
  • Accepted
    09 Feb 2026
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