Dental Midline Research Articles

Evaluation of Facial and Dental Midline Discrepancies in Nepalese Population

Introduction: The facial midline is defined by the landmark such as the nose, philtrum, and chin aligned in a straight line. It should be in the center of the face and should coincide with the dental midline. But clinically it is often observed that some discrepancies exist between facial and dental midlines. Thus the aim of this study was to evaluate the facial and dental midline discrepancies.
 Methods: A total of 300 subjects, 150 male and 150 female from People’s Dental College and Hospital were selected. Full facial view standardized photograph with a posed smile with teeth in occlusion was taken with Canon 400D digital SLR. For standardized measurement vertical metallic scale with millimeter, markings were placed on the right side of the patient in all cases. The software program Digimizer image analysis (version 4.6.1) was used to determine the facial and maxillary dental midline.
 Result: This study showed 6.66% of male and 12% of female had perfectly coinciding F1 facial midline (perpendicular from the midpoint of inner canthus distance), F2 facial midline (line joining the midpoint of inner canthus and the midpoint of the base of the nose) and maxillary midline. 26% of males and 28% of females had less than 1mm of the discrepancy of F1 midline to maxillary midline whereas 41% of males and 38% of females had less than 1 mm of a discrepancy between F2 facial midline and maxillary midline. The study also showed that 24% of males and 24.66% of females had none coincidence of any of the midlines with one another.
 Conclusion: Most of the Nepalese have noncoinciding facial and dental midline but females have more coinciding midlines in comparison to males. The shifted facial midlines are more towards the left side in relation to maxillary dental midline.

Evaluation of dental arches in orthodontic patients with condylar hyperplasia in a North Sumatra subpopulation: a cross-sectional study.

Background: Condylar Hyperplasia (CH) is a self-limiting mandibular condyle disorder that shows asymmetry progress conjunction with associated occlusal changes as long as condylar growth is still active and leads to facial asymmetry. This study aimed to evaluate dental arches by analyzing dental arch asymmetry and form in orthodontic patients with CH in a North Sumatra subpopulation. Methods: This is a retrospective study of suspected CH patient's clinical records who sought for the initial orthodontic treatment between January 2015 to March 2019. Patient with facial asymmetry (based on photography, posterior cross bite and midline deviation), positive temporomandibular joint disorder in functional analysis, and no history of facial trauma were included in the study. Dental arch asymmetry was based on the measurement of dental midline deviation, canine tip in the dental arch, distance of the upper canines from the palatal suture, and inter canine distance. The evaluation of dental arch was achieved by comparing arch width and length. Results: There was a significant difference (p<0.05) of upper canine distance from the palatal suture in female patients when evaluating upper dental arch asymmetry. There was a moderate correlation (r=0.379) in midline deviation between upper and lower dental arch. The dimension and dental arch form was mid and flat, and there was moderate correlation (r=0.448) between the upper and lower dental arch form in these CH patients. Conclusion: The evaluation of dental arch symmetry and arch form showed asymmetric occlusal characteristics in orthodontics patient with CH in North Sumatera subpopulation. In treating these patients, we recommend the plaster cast evaluation as essential and routine procedure in order to understand the complexity of occlusal change due to active growth of condylar and limitation in radiography evaluation.

Factors Affecting Total Treatment Time in Patients Treated with Orthognathic Surgery Using the Surgery-First Approach: Multivariable Analysis Using 3D CT and Scanned Dental Casts.

The aim of this study was to analyze factors affecting treatment times in patients treated with the surgery-first approach (SFA) for orthognathic surgery. Fifty skeletal class III patients who had undergone SFA bimaxillary orthognathic surgery were enrolled. Retrospective chart reviews and analysis of 3D CT and digitally scanned casts were conducted to assess the total treatment time. Statistical analysis was then performed with multiple study variables. Longer treatment times were required for patients with severe maxillary or mandibular teeth crowding (p = 0.009), a preoperative anterior open bite (p = 0.021), and those undergoing orthodontic extractions (p < 0.001). Longer treatment times were also observed when setting surgical occlusion in the postoperative anterior open bite (p = 0.007) and in patients with postoperative dental midline deviation (p < 0.001) and transverse maxillary deficiencies (p = 0.035). Treatment times were shorter when a class I molar key was formed in the surgical occlusion setup (p = 0.002) and in bilateral anterior and posterior occlusion with a minimum of four contact points (p < 0.001). The number of contact points, the number of extracted teeth, and postoperative midline deviation were identified as significant predictors. These results suggest that proper patient selection is important when considering SFA and that surgeons can reduce total treatment time with an appropriate surgical occlusion setup.

Smile outcome comparison of Invisalign and traditional fixed-appliance treatment: A case-control study

The purpose of this study was to evaluate and compare smile treatment outcomes between patients treated with Invisalign clear aligners (Align Technology, Santa Clara, Calif) and those treated with traditional fixed appliances by integrating variables such as lip symmetry, smile index, smile cant, buccal corridors, and gingival display into smile outcome evaluation. Records from 58 patients, 29 of whom received Invisalign treatment (mean age 19.03years) and 29 of whom received traditional fixed-appliance treatment (mean age 13.83years), were compared for their smile outcome. Pretreatment scores, posttreatment scores, and differences between within-group smile score before and after treatment were determined for each group. Fifteen variables comprised the smile outcome, and the data were analyzed with the Mann-Whitney U test and the Wilcoxon t test for 2 dependent samples. Six variables within the fixed-appliance group presented with better smile scores than those within the Invisalign group; buccal corridors (%) (mean difference=8.42%), buccal corridors (mm) (5.35mm), smile cant (0.42°), maxillary dental midline (0.21mm), gingival display (0.56mm), and smile index (1.09%) for P<0.05. Invisalign performed better on 2 variables that determined maxillary incisor position (1.26mm) and inclination (2.09°). No significant difference (for P=0.05) was shown between pretreatment and posttreatment scores for either of the 2 groups. Using the 15 variables in this study, the results suggested that for patients with Class I nonextraction, treatment with traditional fixed appliances changes the patient's smile more than Invisalign treatment, and fixed appliances appear to be more effective in improving the variables that quantify posttreatment smile outcome.

Esthetic assessment of celebrity smiles

Statement of problemGuidelines for planning esthetic outcomes are sparse. The present study evaluated the most noticeable characteristics of the celebrities with the most esthetic smiles. PurposeThe purpose of this observational study was to assess the smiles of celebrities based on descriptive esthetic smile criteria and to compare male and female celebrity smiles based on dentally esthetic smiles. Material and methodsAn internet search for the “most beautiful celebrity smile ranking” was conducted in 2019, resulting in 50 celebrities that had been voted for having the most beautiful smiles. A second search was conducted to locate images of the identified individuals with the whole face and a broad smile. ResultsThe most frequent characteristics of the studied variables were a normal smile line (70.7%), incisal edges parallel to the lower lip (56.1%), maxillary anterior incisal edges touching the lower lip (48.8%), a smile width of 10 teeth (53.7%), a facial midline coincident with the maxillary dental midline (51.2%), and average buccal corridors (78%). Statistically significant differences between men and women were only found in the smile arch (P<.01). ConclusionsCelebrities voted as having the most beautiful smiles comply with most of the characteristics described as esthetically pleasing, except for midline deviations. The general population is influenced by factors other than the individual’s smile.

Esthetic dental perception comparisons between 2D- and 3D-simulated dental discrepancies

Statement of problemIntraoral scanners (IOSs), facial scanners (FSs), and computer-aided design (CAD) software programs have become powerful tools for treatment planning. However, discrepancies in perception regarding 2-dimensional (2D) or 3-dimensional (3D) simulations by dentists, dental students, and laypeople have not been analyzed. PurposeThe purpose of this observational study was to analyze the perceptions of laypersons, dental students, and dentists regarding disparities of the maxillary dental midline and the occlusal plane when analyzing the dental discrepancies on 2D- and 3D-clinical simulations. Material and methodsA female model was digitized by using an FS, IOS, and a full-face smile photograph. Dental discrepancies were simulated by using a 2D photograph (2D group) and 3D scan (3D group) of the model. In both simulation groups, 2 subgroups were produced. The occlusal plane of the first subgroup was modified in 1-degree increments without changing the dental midline or the position of the maxillary dental incisors. In the second subgroup, the occlusal plane was modified by using the same increments, but the maxillary central incisors and dental midline were altered to match the inclination of the occlusal plane. A total of 300 participants (N=300) were asked to rate the 2D images (N=12) and 3D videos (N=12) on a 1-to-6 scale and answer a questionnaire. Ordinal logistic regression was used to analyze the ratings. ResultsThe ratings decreased with the increased tilt of the occlusal plane, and the layperson group gave consistently higher ratings than the other 2 groups. For dentists, the odds of giving a higher versus lower rating decreased by almost a half for each degree of tilt. However, for students, that effect was diminished by a positive interaction term, and for laypersons, the effect was even less. Students gave similar ratings to dentists, but laypersons gave higher ratings. As the age of the participants increased, however, the ratings also increased. The use of 3D versus 2D images had a positive effect on the ratings, but the effect decreased for the student observers and decreased even further for laypersons. Furthermore, midline alteration led to higher ratings but also resulted in worsening of the odds ratio for the tilt. Seventy percent of the dentists, 57% of the dental students, and 52% of the laypersons preferred 2D simulations to 3D simulations. ConclusionsDentists, dental students, and laypersons decreased their ratings with increased inclination of the occlusal plane; however, laypersons still graded all the 2D and 3D images as esthetically pleasant, giving consistently higher ratings than the dentists and dental students. Overall, 3D simulations obtained higher ratings than 2D images, but the positive effect decreased for the student observers and decreased even further for laypersons.

Prevalence of Dental Midline Shifting in a Sample of Orthodontic Patients in Erbil City

Aim of the study: the study aimed to determine the prevalence of dental midline shifting in a group of orthodontic patients.&#x0D; Methodology: The study was conducted on 506 orthodontic patients (183 boys and 323 girls), between13-40 years old, who came to orthodontic department, college of dentistry. The data collected from orthodontic records were analyzed according to the gender, type of dentition and Angle Classes of malocclusion. Dental Midline shifting was observed on patient with respect to patient’s facial midline. SPSS version 20.0 for windows was used for data analyses using Chi-square Pearson tests and Fischer exact tests. Level of significance was set at p&lt;0.05.&#x0D; Results: Around half of the total orthodontic patients had dental midline shifting (49.41 %) which was greater in the maxilla (25.89%) than the mandible (23.52%) slightly. The prevalence of dental midline shifting was more in girls (30.2%), with permanent dentition (48.02%) and with Class I (26.28%) and Class II (18.18) malocclusion.&#x0D; Conclusions: The prevalence of maxillary-mandibular dental midlines was seen in around half of orthodontic patients only. Class I patients were found to have maximum dental midline shift.

Without mini-plates, mini-implants and surgery: treatment of severe anterior open bite in an adult patient - a case report

Introduction: Currently, there is a tendency to treat open bite with mini-implants, miniplates, and orthognathic surgeries and build ups when these protocols are not always indicated and to be apply them unnecessarily and excessively. Objectives: This case report describes treatment of a severe anterior open bite in an adult patient with step bends and vertical elastics. Case report: The female patient was 29 years and 8 months old and reported that she had low self-esteem; therefore, she wanted to have her untreated open bite closed. By examination, a convex profile, vertical growth pattern, dental midline deviation, and tongue exposure could be seen upon smiling. The dental and skeletal sagittal relationship was Class II. The overjet was +5 mm and the anterior overbite was -5.5 mm. The severe skeletal open bite involved the first molars to the anterior teeth, and it was treated only with step bends and vertical elastics over 2 years. Results: Significant facial improvement, maxillary incisor exposure upon aesthetic smiling, and adequate overbite and overjet were observed. The upper and lower dental midlines fit to the sagittal line. A counterclockwise rotation of the mandible was observed. The severe skeletal open bite was treated. Conclusions: Severe skeletal open bite malocclusion treated with step bends and vertical elastics in adult patient demonstrated efficient, predictable and stable open bite correction.

Dental midline correction using a cantilever spring: A novel approach

A 13-year-old patient presented with Angle's Class II subdivision right malocclusion with anterior crowding, protruded lower incisors, and a lower arch that was skewed to the left. A morphological lower midline shift of 3 mm to the left was detected. Following extraction of the upper and lower first premolars, full-arch 0.022” MBT™ appliances were placed in both arches. A 0.018” × 0.025” stainless steel archwire was split into two posterior segments and an anterior segment from the right lateral incisor to the left canine including an open vertical helical loop extending apically toward the center of resistance of the consolidated anterior segment. Subsequently, a 0.017” × 0.025” titanium–molybdenum alloy cantilever spring from the right first molar auxiliary tube was bent buccally and connected to the loop with an elastomeric chain to achieve lower midline correction by translation. Midline correction with the use of segmented-wire technique and cantilever spring provides an effective method of incisor movement by translation with minimal side effects.

Management of a female with amelogenesis imperfecta: clinical report

A 21-year-old young female complained from ugly appearance due to brown discolored and small teeth due to hypocalcified amelogenesis imperfecta (AI). AI clinical manifestations commonly include unsatisfactory esthetics, dental sensitivity, attrition, deep bite, dental midline shift and loss of occlusal vertical dimension due to the rapid wearing of dentition. Treatment of AI is important not only because of esthetic and functional concerns, but also to develop a positive psychological attitude in the patient and a multidisciplinary approach is often necessary. Treatment planning is governed by factors such as the age and socioeconomic status of the patient, the type and severity of the disorder and the intraoral condition at the time of presentation. This clinical report describes the treatment for a young female patient with AI and loss of occlusal vertical dimension using monolithic full contour zirconia restorations.

Potencijalni faktori koji utiču na percepciju estetike osmeha kod odraslih pacijenata stomatološke klinike Univerziteta Jazan

Introduction: Aesthetic smile is an important part for every patient since it plays a vital role in his personality, selfconfidence and self-esteem. Aim: To assess the relationship between the potential factors affecting the perception of aesthetic smile among adult patients, to evaluate the patient's satisfaction toward their smile and to find the most common factors for their dissatisfaction caused by smile. Materials and methods: A 100 males and 100 females were evaluated for the presence or absence of aesthetic smile. The clinical examination was included categories related to personal aesthetic factors of the smile. A questioner designed by Goldstein to measure the patient's self-perception and satisfaction of their smiles was used. The data were pooled for analysis, statistical significance was set to p-value ˃ 0.05. Results: There was a significant differences in the parallel interpupillary line and coincided of dental midlines alone and with facial midlines in the aesthetic and non-aesthetic choices, also between the symmetry of maxillary central and lateralicisors, and canines with their axial inclinations choices (p&lt; 0.05). Some group of questions showed significant differences among female and male subjects while, the male subjects Some questions were near to the statistical significant differences, while others showed no significace between males and females choices. Conclusion: Dental and facial factors showed highly significant relationship with aesthetic smile. So, it should be observed by a dental specialist to provide a proper treatment plan with respect to the potential factors of the aesthetics to help for self-satisfaction measurement.

Assessment of the Relationship Between Facial and Dental Midlines with Anatomical Landmarks of the Face and Oral Cavity.

The purpose of the present study was to determine the facial anatomical landmarks, in order of accuracy, closest to the midline of the face, as well as oral cavity midline, and to specify which intraoral anatomical landmarks are closer to the dental midline. Three commonly used anatomical landmarks including nasion, nose, and philtrum tips were marked clinically in 108 subjects. A frontal full-face digital image was used for midline analysis in accordance with the esthetic frame. Deviations from the facial and oral midlines were measured for the three clinical landmarks. Dental midline was considered as the fourth landmark. Alginate impressions were taken, and casts were analyzed under standardized conditions. The labial frenum and incisive papilla were marked. Cast images were taken and analyzed. Data showed difference between the mean ratios of the selected anatomical landmarks and the facial and oral midlines (p≤0/05). The anatomical landmark hierarchies, in proximity to the facial midline, are commissural midlines, nasion, philtrum tip, nose tip, and dental midline, respectively. The anatomical landmark hierarchies, in proximity to the commissural midline, include dental midline, philtrum tip, nose tip, and nasion. The labial frenum was less deviated from the dental midline than the incisive papilla. With respect to shortcomings, the results showed that all of the anatomical landmarks were deviated from the facial and oral midlines. The order of proximity of the anatomical landmarks to the facial midline was as follows: commissural midline, nasion, philtrum, and dental midline.

Incisor root resorption associated with palatally displaced maxillary canines: Analysis and prediction using discriminant function analysis

Incisor root resorption associated with palatally displaced canine (PDC-IRR) is an important phenomenon that might alter the orthodontic treatment plan. The aims of this study were to investigate the prevalence and characteristics of PDC-IRRs, to compare PDC-IRR and PDC-No-IRR groups, to identify predictors for PDC-IRR, and to produce a valid PDC-IRR prediction model using discriminant function analysis. Cone-beam computed tomography images for 107 palatally displaced canines (PDCs) and 51 fully erupted nondisplaced canines (NDC) were analyzed for the presence of incisor root resorption (IRR). The PDCs were divided into 2 groups: PDC-IRR (52 canines) and PDC-No-IRR (55 canines). The 3 groups were compared, and the following variables were measured: canine follicle size, contact with adjacent incisors, associated dental abnormalities, sector analysis, canine vertical relation to adjacent root, lateral incisor angulation and inclination, canine angulation and distance to reference planes (dental midline, midpalatal suture, occlusal plane, pterygoid vertical plane, and lateral incisor), and space available for canine in the dental arch. Discriminant functional analysis was used to produce a discriminant function equation to predict PDC-IRR. Root resorption affected 74% of lateral incisors adjacent to PDCs and 25.5% of lateral incisors adjacent to NDCs. IRR was located lingually in 41% of PDCs and in the mid and apical thirds in 89%. In the PDC-IRR group, 94.2% of canines were in contact with adjacent roots compared with 23.6% in the PDC-No-IRR group (P<0.001). Canine follicle size was>2mm in 42% of PDC subjects. Overall mean value of follicle width in PDC canines was 1.79±1.06mm. Peg-shaped lateral incisors were recorded in 19% of PDC subjects compared with 4% in NDCs (P=0.012). The stepwise analysis using cone-beam computed tomography records produced a discriminant function based on 3 variables. The analysis correctly predicted the outcome in 83% of subjects. The variables contributing to the prediction equation were canine contact with adjacent incisors, size of canine dental follicle, and the presence of peg-shaped lateral incisor. Canines in contact with adjacent incisor roots was the only risk factor detected for PDC-IRR. Very good predictive discrimination (83%) emerged for PDC-IRR subjects. Predictors of PDC-IRR were canine contact with adjacent incisor, size of canine dental follicle, and presence of peg-shaped lateral incisor.

WILLIAMS-BEUREN SYNDROME AND ORAL FINDINGS

Williams-Beuren syndrome (WBS; OMIM #194050) is a developmental disorder characterized by congenital heart disease, intellectual disability, dysmorphic facial features and ophthalmologic abnormalities. Virtually every organ and system can be affected in WBS as a result of haploinsufficiency. Most cases are sporadic, although familial cases with autosomal dominant inheritance have been reported. Oral abnormalities are also described in clinical manifestations of the disease. This study describes orofacial features in 17 patients with WBS. Patients with a confirmed molecular diagnosis of WBS were examined for oral abnormalities through clinical oral evaluations and panoramic radiography. Malocclusion, specifically with dental midline deviation, and high-arched palate were the most common oral findings. The present study contributes to the knowledge of orofacial manifestations in WBS. Since such patients with WBS may develop severe oral abnormalities, early detection and treatment can help to improve their quality of life.

Establishing a Protocol for Closed Treatment of Mandibular Condyle Fractures with Dynamic Elastic Therapy

Treatment of mandibular condyle fractures is controversial. Open treatment achieves anatomic reduction with occlusal stability and faster functional recovery but risks facial nerve injury and jeopardizes joint capsule circulation which can lead to bone resorption. Traditional closed treatment avoids these issues but requires prolonged fixation and risks subsequent facial asymmetry, occlusal disturbance, and ankylosis. Rather than wires, closed treatment with elastics allows for customizable management of a healing fracture with ability to alter vector and degree of traction to restore vertical height and occlusion with less discomfort and decreased risk for ankylosis. In this protocol, unilateral condylar fractures were treated with class II elastics ipsilateral to injury and class I contralaterally. Class III elastics were used contralaterally if additional traction was required and Class II elastics were placed bilaterally for bilateral fractures. Patients were sequentially advanced from fixating to guiding to supportive elastics by titrating elastic vector to any dental midline incongruency or chin deviation. Six patients were treated with this protocol with six-month follow-up. Fracture patterns included displaced and dislocated fractures as well as intracapsular and extracapsular condylar fractures. All patients at completion of the protocol had objective centric occlusion with no subjective malocclusion, chin deviation, facial asymmetry, or temporomandibular joint pain. These early data demonstrate a safe and efficacious innovative protocol for closed treatment of mandibular condylar fractures with dynamic elastic therapy.

Photoelastic analysis of tension distribution in different orthodontic approaches for closing anterior open bites.

This study aims to evaluate tension distribution in the anterior region of the mandible during two orthodontic mechanical approaches to treat anterior open bite. It was an in-vitro experimental study, that analyzed 5 models of photoelastic resin, simulating a lower dental arch. The anterior teeth underwent orthodontic forces of the Blue Elgiloy® 0.016" x 0.022" (MEAW technique) and Gummetal® 0.018"x 0.022" (GEAW technique) archwires. Tension distribution was assessed on three different points in the lower dental midline and was measured using a reflection polariscope. The archwires were evaluated with and without anterior elastic bands (6 oz, 170 g) installed between lateral incisors and lower canines, as recommended for anterior open bite. The highest magnitudes of tension generated by the archwires were observed in the cervical regions of the teeth (on average 50% higher than those at the most apical point) regardless of the technique used. Comparatively, the GEAW technique showed significantly (P<0.05) lower tension values (16 MPa) than the MEAW technique using Blue Elgiloy (24 MPa). The GEAW technique showed a more favorable tension distribution pattern than the MEAW approach. The use of elastic bands improved tension distribution, regardless of the technique. The results also suggest that the use of anterior elastic bands in both techniques reduced the tensions released by the intrusive forces generated by the archwires.

Horizontal change of philtrum after orthognathic surgery in patients with facial asymmetry

BackgroundSoft tissue asymmetry such as lip canting or deviation of the philtrum is an important influencing factor for unbalanced facial appearance. Lip canting could be improved by the correction of the occlusal canting or positional change of the mentum. Although there are many studies about changes of lip canting, however, postoperative changes of philtrum deviation have not been yet reported. In this study, we investigate the positional change of the philtrum after orthognathic surgery and influencing factors.MethodsPositional change of the philtrum was evaluated in 41 patients with facial asymmetry who underwent bimaxillary surgery, in relation to other anatomical soft tissue landmarks using a frontal clinical photo. The surgical movement of the maxillary and mandibular dental midline and canting were measured in postero-anterior cephalogram before and 1 day after surgery. The same procedure was repeated in patients with more than 1.5 mm perioperative change of the mandibular dental midline after bimaxillary surgery.ResultsMaxillary dental midline shifting and canting correction did not have a significant correlation with lateral movement of the philtrum midline. However, the mandibular shift had a statistically significant correlation with a lateral movement of the philtrum (p < 0.05) as well as other linear parameters and angle values.ConclusionThe horizontal change of the philtrum is influenced by lateral mandibular movement in patients with facial asymmetry, rather than maxillary lateral movement.

A Nomenclature Coding System for Facial and Dental Midline

Facial and dental midlines are an essential diagnostic feature in orthodontic treatment planning. Interpreting the deviation helps us to establish a proper treatment plan. This article describes an easy way to record and interpret a new nomenclature coding system for facial and dental midlines.

Orthodontic treatment of class three malocclusion using clear aligners: A case report

Class III malocclusion is a growth-related challenging condition for orthodontists. We present a case of a 11-year-old girl with a skeletal class III malocclusion with bilateral cross bite, and a functional shift of the lower dental midline. A multiphase clear aligners' treatment was scheduled with the aim of removing all dental interferences which involved an anterior displacement of the mandible. At one-year follow-up, clear aligners’ therapy resulted in skeletal and dental improvements. Clear aligners therapy represents a valid alternative to fixed appliance therapy in the early interception of class III malocclusion. The present manuscript was prepared following the CARE guidelines.

Perbedaan Persepsi Antara Mahasiswa Pre-Klinik Dan Klinik Terhadap Midline Shifting Pada Gigi Tiruan Lengkap

Background: Facial aesthetic is affected by components that can be observed from the face as a whole (macro-esthetics), and also from the dental components (micro-esthetics). Ideally, the dental midline of a complete denture should coincide with the facial midline of the wearer (i.e. no midline shifting). Among others, one of the main aims of using complete dentures for prosthodontics treatments is to improve facial aesthetic. Consequently, the ability and competency of a dentist to detect midline shifting is vital in order to attain a complete denture with optimal esthetics. In dentistry, the relationship between individual perception of midline shifting and the level of education is often studied. Apart from gender and age, other factors such as the level of education can influence individual’s perception towards midline shifting. The objective of this study is to find out the difference between the perception of pre-clinical and clinical students towards midline shifting in complete dentures. The type of study is cross-sectional observational analytic. Materials and Methods: This study involves 128 pre-clinical and clinical students in FKG Universitas Trisakti. The student’s perception towards midline shifting is measured using 9 photos and a questionnaire. Results: 128 dental students with equal distribution between pre-clinic and clinic students participated in this study. Data analysis showed difference of perception between the two groups (p-value 0.016). Conclusions: There is a significant difference between the perception of pre-clinical and clinical students in FKG Universitas Trisakti towards midline shifting in complete dentures.