PURPOSE: The purpose of this systematic review was to examine the existing evidence on dental proportion to evaluate the existence of RED proportions in the esthetic smile in different geographic regions.
MATERIAL AND METHODS: A systematic search was conducted by reviewing different databases. The focused question was "Does RED proportion exist in esthetically pleasing smiles in different populations around the world?" The search included articles with a combination of MeSH keywords based on dental proportion from January 2000 to July 2020. The titles and abstracts were identified by using a search protocol. Full text of the articles was independently evaluated. The systematic review was modified to summarize the relevant data. The general characteristics, outcomes, and quality of studies were reviewed and analyzed systematically.
RESULTS: Seventeen studies were selected from the reviewed articles. Three studies were conducted in Europe, 10 in South Asia, and 4 in Western Asia. Eleven studies found that the mean perceived ratio of anterior teeth was not constant when progressing distally. Five studies reported that the ratio was constant in a small percentage of their populations, and 1 suggested that the ratio was constant if it remains between 60% and 80%. The central-to-LI and Ca-to-LI proportion values were not constant. Overall, the Ca-to-LI proportion values were higher than the central-to-LI proportions.
CONCLUSIONS: RED proportions were not found in the successive widths of maxillary anterior teeth among the reviewed data from different geographic regions. RED proportions are not the only standard for restoring esthetic smiles worldwide, and anterior tooth proportions differ among populations based on their race and ethnicity.
METHODS: A cross sectional study was conducted on a sample of 527 children from four schools located in Lahore, Pakistan. A 14-point questionnaire was developed, using existing measures of peer pressure, and popularity. The selected questions were modified to investigate the issues of dental aesthetics and integrated into the WHO oral health questionnaire for children.
RESULTS: More than 50 % of the participants indicated popularity issues regarding dental aesthetics. 63.5 % of the responses indicated an influence of relatives and friends, whereas 38 % responses reported of harassment and bullying at schools. Regression analysis shows that the females were 1.99 times more likely to get comments from relative or friends about their teeth and 2.17 times more likely to be bullied or harassed at school due to their teeth when compared to the males. Fathers with a higher education brought about higher popularity and peer pressure issues. Mothers with a higher education were less likely to cause popularity and peer pressure issues than mothers with a lower education. Popularity and peer pressure were both significantly related to higher dental visitation.
CONCLUSIONS: Popularity and peer pressure have a direct link to dental aesthetics in an individual and are impacted by gender, family relatives and parental influences. The area of popularity and peer pressure related to dental aesthetics can be targeted in health education programs to empower children to adopt better oral health behaviours.
METHODS: Two sets of 3-dimensional facial photographs (1 male and 1 female) each comprised 7 images that showed different dentoskeletal relations (ie, Class I, bimaxillary protrusion, bimaxillary retrusion, maxillary protrusion, maxillary retrusion, mandibular protrusion, and mandibular retrusion). The sets of photographs were shown to 101 laypersons (age, 28.87 ± 6.22 years) and 60 patients seeking orthognathic treatment (age, 27.12 ± 6.07 years). They rated their esthetic perceptions of the photographs on the basis of a 100 mm visual analog scale (VAS) from 0 (very unattractive) to 100 (very attractive).
RESULTS: The dentoskeletal Class I facial profile was ranked as the most attractive profile. Female orthognathic judges selected the retrusive maxilla while male orthognathic judges and male and female laypersons ranked the mandibular protrusion profile as the least attractive profile for both females and males. A bimaxillary protrusive female profile was viewed as more attractive by the orthognathic male (P = 0.006) and female (P = 0.006) judges, compared with female layperson judges. After adjustment for age, no statistically significant interaction between sex and judges (P >0.10) for all VAS scores were detected. For the female bimaxillary protrusive profile, orthognathic patient judges assigned a mean VAS score of 9.174 points higher than layperson judges (95% confidence interval, 3.11-15.24; P = 0.003).
CONCLUSION: Dentoskeletal Class I facial profile was generally considered the most attractive profile in both sexes; male and female orthognathic patients preferred a bimaxillary protrusive female profile. A concave facial profile was perceived as least attractive in both sexes.
OBJECTIVES: The aim of this in vitro study was to evaluate the long-term effects of various staining solutions on the color stability of different temporary materials produced with the computer-aided design and computer-aided manufacturing (CAD/CAM) technology.
MATERIAL AND METHODS: In the study, the following materials were used: VITA CAD-Temp® (group 1); Ceramill® Temp (group 2); and Telio® CAD (group 3). Forty disk-shaped specimens (10 mm in diameter, 2 mm in thickness) of each material (N = 120) were produced with a CAD/CAM system. Staining solutions - of tea (A), of coffee (B) and cola (C) - and distilled water (D, control) were used, and color was evaluated before and after storing the samples in the solutions. Measurements were taken with a spectrophotometer and the color parameters (L*, a*, b*, and ΔE) were calculated according to the Commission internationale de l'éclairage system (CIELab). The results were evaluated with the two-way analysis of variance (ANOVA) and Tukey's tests (α = 0.05).
RESULTS: Clinically perceivable (ΔE00 > 0.8) and statistically significant (p < 0.001) color differences were detected in all specimens. The highest ΔE00 value was found in the Ceramill Temp specimens. In addition, the highest ΔE00 values were noted for the specimens stored in cola and the coffee solution for all groups. The lowest ΔE00 value was observed for the groups stored in the tea solution.
CONCLUSIONS: Clinically perceivable color changes were observed in all the specimens kept in the solutions. Color changes were greater for cola and coffee as compared to tea.
METHOD: This case series report includes all 19 consecutive cases presenting to the Chang Gung Craniofacial Center for combined orthognathic surgery with Asian double eyelid suture method blepharoplasty. The double eyelid crease height was measured as the vertical line between the upper eyelid margin (eyelid lash) and the upper eyelid crease, observed at the mid-pupillary line with the eyes in primary gaze.
RESULTS: There were no complications or relapse reported within this time period. There was significant improvement in the left and right mid-pupillary double eyelid crease height postsurgery. There were no statistically significant differences between the left and right mid-pupillary double eyelid crease heights after surgery indicating good eyelid crease height symmetry bilaterally was obtained.
CONCLUSIONS: Orthognathic surgery combined with suture method blepharoplasty can be safely performed in the same surgical setting without inappropriate rise in costs or operating room time. This case series demonstrates that excellent esthetic results can be obtained in simultaneous bimaxillary orthognathic surgery with suture method Asian blepharoplasty.
MATERIALS AND METHODS: In this cross-sectional study, 206 Malaysian adolescents (age: 11-18 years) were screened in orthodontic clinics to identify those with normative need, oral impacts due to malocclusion, and having high and medium-to-high behavioural propensities. The Index of Orthodontic Treatment Need classified normative need. The Psychosocial Impact of Dental Aesthetics (PIDA) questionnaire and the Condition-Specific Child-Oral Impacts on Daily Performances (CS-OIDP) index measured oral impacts. Subjects' behavioural propensities for successful treatment outcome were based on the Basic Periodontal Examination and International Caries Detection and Assessment System. Data were analysed using the McNemar test.
RESULTS: The response rate was 99.0%. Estimates of normative need (89.7%) were significantly reduced under the sociodental model by 65.7% (p
METHODS: Participants were 7- to 16-year-old children referred to a UK Dental Hospital for management of incisor opacities. Prior to treatment (To), participants completed validated questionnaires to assess OHRQoL and overall health status (C-OHIP-SF19), and self-concept (Harter's Self-Perception Profile for Children [SPPC]). Interventions for MIH included microabrasion, resin infiltration, tooth whitening or composite resin restoration. Children were reviewed after six months (T1) when they re-completed the C-OHIP-SF19 and SPPC questionnaires. The relationships of predictors with improvement of children's OHRQoL (T1-To) and children's overall health status at T1 were assessed using linear and ordinal logistic regression respectively, guided by the Wilson and Cleary's theoretical model.
RESULTS: Of 103 participants, 86 were reviewed at T1 (83.5 % completion rate). Their mean age was 11-years (range = 7-16) and 60 % were female. Total and domain OHRQoL scores significantly increased (improved OHRQoL) following MIH treatment. There was a significant positive change in SPPC physical appearance subscale score between To and T1. A higher number of anterior teeth requiring aesthetic treatment were associated with poor improvement of socio-emotional wellbeing at T1 (Coef =-0.43). Higher self-concept at To was associated with greater improvement of socio-emotional wellbeing at T1 (ß = 3.44). Greater orthodontic treatment need (i.e. higher IOTN-AC score) at T0 was linked to worse overall oral health at T1 (OR = 0.43).
CONCLUSIONS: Psychosocial factors and dental clinical characteristics were associated with change in children's OHRQoL following minimal interventions for incisor opacities.
CLINICAL SIGNIFICANCE: MIH is a common condition and clinicians should be aware of the negative impacts some children experience, particularly those with multiple anterior opacities, poor tooth alignment and low self-concept. However, simple, minimally invasive treatments can provide good clinical and psychosocial outcomes and should be offered to children reporting negative effects.
METHODS: A random sample of 800 schoolchildren aging 11-15 years was selected from different schools in the city of Dhaka, Bangladesh. The Dental Health Component (DHC) and Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN) were assessed as normative treatment need. The Decayed, Missing, Filled Teeth (DMFT) index was used to record caries experience. Children were interviewed on the perception of orthodontic treatment need. Parents also completed a questionnaire on the perception of their child's orthodontic treatment need, assessed by AC/ IOTN.
RESULTS: According to the DHC/IOTN, only 24.7% were in the category of definite need (grade 4-5) for orthodontic treatment. A significant difference was found between the clinician/children and clinician/parents perceived AC score of IOTN (p= 0.0001). Multiple logistic regression showed children with a higher DMFT were significantly more likely to need orthodontic treatment, according to the DHC of IOTN.
CONCLUSION: A low proportion of schoolchildren needs normative orthodontic treatment in the city of Dhaka, Bangladesh. Children with a higher DMFT score were significantly more likely to need orthodontic treatment, according to the DHC of IOTN.
METHODS AND MATERIALS: A prospective study was conducted between April 2016 and May 2017. Twenty two adult patients aged 18-38 years with gummy smile ranging from 4 to 6 mm because of soft tissue disorders were included in the study. All patients were treated in the oral and maxillofacial department at Damascus University. The sample was divided into two groups of 11 patients. The first group was treated by the conventional standard technique, and the second group treated by a modified study technique. The amount of gingival display in full smile was evaluated in both groups following each intervention.
RESULTS: Both groups exhibited a statistically significant reduction in the measurement of gummy smile at month 1 and 6 postoperatively (P .05). The recent study showed a significant difference in gingival display between 3 and 6 months postoperatively in group 1, but no significant difference in group 2.
CONCLUSION: This study showed that the modified technique utilized in treating gummy smile has less relapse after surgery, shows excellent cosmesis and compared to the conventional technique, greater sustainability.
CLINICAL SIGNIFICANCE: The recent increase in demand for an esthetic smile has led to the development a modification of conventional lip repositioning for correcting gummy smile by myotomy of lip elevator muscles. This modified technique offers less relapse and greater stability post-operatively than the conventional technique.
PURPOSE: The purpose of this study was to determine esthetic perceptions of the Malaysian population regarding the width of buccal corridor spaces and their effect on smile esthetics in individuals with short, normal, and long faces.
MATERIAL AND METHODS: The image of a smiling individual with a mesofacial face was modified to create 2 different facial types (brachyfacial and dolicofacial). Each face form was further modified into 5 different buccal corridors (2%, 10%, 15%, 22%, and 28%). The images were submitted to 3 different ethnic groups of evaluators (Chinese, Malay, Indian; 100 each), ranging between 17 and 21 years of age. A visual analog scale (50 mm in length) was used for assessment. The scores given to each image were compared with the Kruskal-Wallis test, and pairwise comparison was performed using the Mann-Whitney U test (α=.05).
RESULTS: All 3 groups of evaluators could distinguish gradations of dark spaces in the buccal corridor at 2%, 10%, and 28%. Statistically significant differences were observed among 3 groups of evaluators in esthetic perception when pairwise comparisons were performed. A 15% buccal corridor was found to score esthetically equally within 3 face types by all 3 groups of evaluators. The Indian population was more critical in evaluation than the Chinese or Malay populations. In a pairwise comparison, more significant differences were found between long and short faces and the normal face; the normal face was compared with long and short faces separately.
CONCLUSIONS: The width of the buccal corridor space influences smile attractiveness in different facial types. A medium buccal corridor (15%) is the esthetic characteristic preferred by all groups of evaluators in short, normal, and long face types.
METHODS: Patients in the permanent dentition requiring maxillary and mandibular fixed orthodontic treatment with a preadjusted edgewise appliance were eligible for inclusion. Patients attending 4 hospital departments (United Kingdom and Italy) were randomly allocated to 1 of 4 treatment interventions: (1) BioCosmetic (Forestadent, Pforzheim, Germany), 0.017 in; (2) Titanol (Forestadent), 0.016 in; (3) TP Aesthetic (TP Orthodontics, La Porte, Ind), 0.014 in; and (4) Tooth Tone (Ortho Organizers, Calsbad, Calif) 0.016 in. Block randomization with block sizes of 4 and 8 was used to ensure an allocation ratio of 1:1:1:1. The primary outcome was alignment efficiency determined by the reduction in Little's irregularity index (mm). Secondary outcomes were color change using the Commission Internationale de L'Eclairage L*a*b* system and percentage of coating loss. Blinding was only applicable to outcome assessment of alignment efficiency. Regression models with Sidak's multiple comparison of means were used to analyze the data.
RESULTS: One hundred fifty patients (300 dental arches) were allocated to the treatment interventions, including 61 male and 89 female subjects with a mean age of 16.60 years. The average duration of follow-up was 63.65 days. Baseline characteristics for the archwire groups were similar. One patient was lost to follow-up. Five percent (n = 15) of the archwires fractured: BioCosmetic, 5.3% (n = 4); Titanol, 6.8% (n = 5); TP Aesthetic, 5.3% (n = 4); and Tooth Tone, 2.7% (n = 2). We analyzed 283 dental arches for alignment efficiency. There was no statistically significant difference for mean reduction in irregularity between the archwire groups (P = 0.627): BioCosmetic (n = 71), 3.86 mm (95% CI, 3.31-4.41); Titanol (n = 69), 4.51 mm (95% CI, 4.00-5.02); TP Aesthetic (n = 71), 4.13 mm (95% CI, 3.49-4.78); and Tooth Tone (n = 72), 4.21 mm (95% CI, 3.89-4.46). There was a statistically significant difference between archwire groups for color change (P = 0.001) and percentage of coating loss (P = 0.001), with BioCosmetic performing best in both parameters.
CONCLUSIONS: There was no difference between the archwires for alignment efficiency. BioCosmetic performed statistically significantly better than did the other groups for both color change and coating loss.
REGISTRATION: This trial was registered with the East Midlands NHS Research Ethics Committee (12/EM/0190).
PROTOCOL: The protocol was not published before trial commencement.
METHODS: The published English version of PIDAQ was pilot tested on 12- to 17-year-old adolescents, resulting in a few modifications to suit the Malaysian variety of English. Psychometric properties were tested on 393 adolescents who attended orthodontic practices and selected schools. Malocclusion was assessed using the Malocclusion Index, an aggregation of Perception of Occlusion Scale and the Aesthetic Component of the Index of Orthodontic Treatment Need, by the subjects (MI-S) and investigators (MI-D). Data were analysed for internal consistency and age-associated invariance, discriminant, construct and criterion validities, reproducibility and floor and ceiling effects using AMOS v.20 and SPSS v.20.
RESULTS: The item Don't like own teeth on video of the Aesthetic Concern (AC) subscale was not relevant to a large proportion of participants (11.7%). Therefore, it was removed and the Malaysian English PIDAQ was analysed based on 22 items instead of 23 items. Confirmatory factor analysis showed good fit statistics (comparative fit index: 0.902, root-mean-square error of approximation: 0.066). Internal consistency was good for the Dental Self-Confidence, Social Impact and Psychological Impact subscales (Cronbach's alpha: 0.70-0.95) but lower (0.52-0.62) though acceptable for the AC subscale as it consisted of only 2 items. The reproducibility test was acceptable (intra-class correlations: 0.53-0.78). For all PIDAQ subscales, the MI-S and MI-D scores of those with severe malocclusion differed significantly from those with no or slight malocclusion. There were significant associations between the PIDAQ subscales with ranking of perceived dental appearance, need for braces and impact of malocclusion on daily activities. There were no floor or ceiling effects.
CONCLUSION: The adapted Malaysian English PIDAQ demonstrated adequate psychometric properties that are valid and reliable for assessment of psychological impacts of dental aesthetics among Malaysian adolescents.
METHODS: The PIDAQ was cross-culturally adapted into Malay version by forward- and backward-translation processes, followed by psychometric validations. After initial investigation of the conceptual suitability of the measure for the Malaysian population, the PIDAQ was translated into Malay, pilot tested and back translated into English. Psychometric properties were examined across two age groups (319 subjects aged 12-14 and 217 subjects aged 15-17 years old) for factor structure, internal consistency, reproducibility, discriminant and construct validity, criterion validity, and assessment of floor and ceiling effects.
RESULTS: Fit indices by confirmatory factor analysis showed good fit statistics (comparative fit index = 0.936, root-mean-square error of approximation = 0.064) and invariance across age groups. Internal consistency and reproducibility tests were satisfactory (Cronbach's α = 0.71-0.91; intra-class correlations = 0.72-0.89). Significant differences in Malay PIDAQ mean scores were observed between subjects with severe malocclusion and those with slight malocclusion based on a self-rated and an investigator-rated malocclusion index, for all subscales and all age groups (p dental appearance and those who felt they needed or did not need braces, showed significant associations for all age groups (p