Dental Midline Research Articles

Tetris Genioplasty 2.0: The Evolution of the Technique

The chin is a key feature in facial aesthetics, contributing essential projection to the profile. Proper alignment ensures facial harmony, while misalignments can create irregularities that may require surgical correction. Over time, various genioplasty techniques have been developed to address a broad range of asymmetries. Tetris Genioplasty is a novel osteotomy technique designed to improve cases where the skeletal midline does not align with the dental midline, delivering significant corrective results. Building on extensive experience with patients presenting this condition, this technical note introduces Tetris Genioplasty 2.0, a refined version of the original “Tetris” Osteotomy. This enhanced technique minimizes the presence of edges during bone segment realignment, resulting in a more seamless facial profile. This study aims to detail the advancements in the Tetris Genioplasty technique, demonstrating how the 2.0 modification offers an optimized approach to improving facial symmetry and aesthetic outcomes in complex midline discrepancies.

Artificial Intelligence in Aesthetic Dentistry: Is Treatment with Aligners Clinically Realistic?

Smile aesthetics are increasingly prioritized in dental practice, with accurate orthodontic assessment and treatment planning being crucial for optimal outcomes. This study evaluates Invisalign® SmileView™ (SV), an AI-based tool that simulates post-treatment smiles, focusing on its ability to present potential orthodontic outcomes to patients. Background/Objectives: This research aims to study whether SV can simulate predictable orthodontic results and if it makes anatomical modifications to the teeth. Additionally, it will evaluate whether SV displays smiles that conform to the orthodontic criteria described in the literature. Finally, the study will analyze whether the software can align the dental with the facial midline. Methods: A total of 51 subjects were recruited in Madrid, Spain. The operator took a frontal photograph of the subjects with a social smile (T0), following the application’s instructions. Subsequently, the subjects followed the steps to modify their smile (T1), resulting in a new image of the subject with a different smile. The following variables were collected, analyzed, and compared with the standards defined in the literature: smile width, vertical exposure of the maxillary central incisor, width of the maxillary central and lateral incisors, proportion of the maxillary lateral incisor width to the central incisor, anterior gingival exposure level, position of the upper and lower dental midlines relative to the facial midline. Results: 58% of the sample showed dental expansion, with an excessive expansion (>5 mm) observed in 8%. In the maxillary arch, 5.9% of incisors exceeded predictable aligner movement (>1.5 mm), with 3.9% showing excessive extrusion and 2% excessive intrusion. For the lateral incisors, the mesiodistal size was reduced less than 0.5 mm in 31.4% of cases, with excessive interproximal reduction (>0.5 mm) in 5.9%. Additionally, 62.7% of cases would require multidisciplinary treatment due to an increase in size. SV centered the upper midline in 77.9% of these cases. Among the sample, the upper midline was initially centered in 74.5% of subjects, and SV maintained it centered in 84.2% of these subjects. Conclusions: SV tends to generate simulations of broader smiles, which are mostly achievable through aligner treatments, from an orthodontic perspective, and showed high predictability regarding the vertical movements of the incisors that can be achieved with aligners. Moreover, it adjusted the mesiodistal size of the upper incisors in its simulations and demonstrated the ability to identify and correct deviations of the dental midlines relative to the facial midline.

Coincidence of the facial and maxillary dental midlines in the Peruvian population. A cross-sectional study.

This study aimed to determine the percentage of perfect and acceptable coincidence between the facial and maxillary dental midlines in individuals from Peru. This was a cross-sectional study of a group of Peruvian individuals gathered from private offices in Lima, Peru, from January to June 2024. A total of 279 patients (133 males and 146 females) aged between 18 and 30 were included. We selected patients with permanent teeth up to their second molars, while those with gaps between their front teeth, ongoing or previous orthodontic treatment, or any craniofacial anomalies were excluded. Using a professional camera, we took frontal photographs of the participants at rest and while smiling. The facial morphological index was used to classify facial biotypes into three categories: mesofacial, dolichofacial, and brachyfacial. We then used the PowerPoint program to analyze perfect and accepted coincidence (deviation to either side of up to 2 mm) between the facial and dental midline. The data was analyzed by chi-square tests and binary logistic regression (p>0.05). Perfect coincidence of the dental midline was present in 23.3% of the cases, while an accepted coincidence was observed in 95.7% of the individuals. When considering facial structure, the percentage of alignment of the maxillary dental midline (perfect or accepted) with the facial midline did not show a significant association (p=0.145, p=0.870, respectively). Furthermore, there were no significant differences in the percentage of alignment between men and women (p=0.241 for perfect coincidence, p=0.322 for accepted alignment). Most Peruvian individuals assessed had an accepted coincidence (up to 2 mm) between the facial midline and the maxillary dental midline, although it is not always perfect. In these cases, orthodontic treatment is needed for optimal occlusal relationships and stable facial esthetics. Key words:Esthetics, Facial midline, maxillary dental midline, Peruvian.

Influence of dental midline deviation with respect to facial flow line on smile esthetics-A cross-sectional study.

A contemporary concept states that dental midline deviation towards the direction of facial flow line (FFL) can mask the compromised smile esthetics. This study aimed to identify a range of midline deviations that can be perceived towards or away from the FFL influencing smile esthetics. A cross-sectional study was conducted using a frontal smile photograph of an adult female. The photograph was altered on Adobe Photoshop software into six different photographs by deviating the dental midlines towards and away from the FFL. A constant deviation of chin towards the left side was incorporated in all the photographs. Forty-three laypersons (LP) and dental professionals (DPs) evaluated those photographs. Independent t-test was used to compare the perception of dental midline deviation between LP and DPs. Simple linear regression was run to identify the factors associated with the scoring. A statistically significant difference was observed for picture two with 4 mm towards FFL in the perception of midline deviation between LP and DPs. LP could not perceive the midline deviations up to 4 mm while DPs were able to perceive deviations above 2 mm. The greater the age the better the scores were and female raters had a greater inclination towards poor scores. From 2 to 4 mm of midline deviation towards the FFL can be tolerated by LP and DPs. These findings underscore the importance of considering facial symmetry in orthodontic and cosmetic dental treatments to optimize smile esthetics.

Impact of Dental Midline Shift on the Perception of Facial Attractiveness in Young Adults.

Background/Objectives: The aim of this study was to quantify the threshold of a dental midline shift that would compromise facial attractiveness and indicate a need for treatment from the points of view of laypeople and dental professionals. Methods: Whole-face natural photographs of a male and a female model were digitally manipulated to create various degrees of upper and lower dental midline shifts through bodily movement of the upper or lower midlines as well as alteration of the axial inclination of the upper teeth. The samples were then assessed by two groups of observers (laypeople (LP) and dental professionals (DP)). Results: The lower midline shift did not negatively affect the DP and LP's perceptions of smile attractiveness. The first significant loss of attractiveness was registered by the DP with an upper midline shift of 1 mm in the female model. However, the LP registered this at 2 mm. The DP registered the necessity of treatment at a threshold of 2 mm in the female model and 3 mm in the male model. LP identified the need for treatment at 3 mm for both males and females. The female model was judged more critically than her male counterpart by both female and male observers. Conclusions: DP assess the midline deviation more critically than LP. Both DP and LP were more sensitive to midline deviations in the female model regardless of their own gender. Both groups registered the need for treatment at a higher threshold than the reduction in smile attractiveness.

Difference in discrepancies of mandibular incisor compensation relative to Menton deviation between Class III roll- and yaw-dominant asymmetries.

To compare mandibular incisor compensation relative to Menton (Me) deviation between skeletal Class III patients with roll- and yaw-dominant mandibular asymmetries. Sixty skeletal Class III patients (21.62 ± 2.69 years) with facial asymmetry were divided into roll- or yaw-dominant asymmetry groups. Mandibular skeletal and incisor measurements were carried out using cone-beam computed tomography data, and values were compared between the two asymmetry groups or between moderate and severe asymmetry subgroups using independent t-test or Mann-Whitney U-test. The relationship between skeletal and dental measurements was assessed using Pearson correlation coefficient. Relative to the mandibular midsagittal plane, the yaw-dominant group presented significantly greater mandibular dental midline deviation in distance (LI-mid deviation, 2.15 mm) and angulation (4.20°) toward the nondeviated side than the roll-dominant group (P < .001). The ratio of amount of LI-mid deviation to Me deviation was significantly greater in the yaw-dominant group (26.44%) than in the roll-dominant group (1.76%; P < .001). In the yaw-dominant group, the LI-mid deviation was significantly greater in the severe asymmetry subgroup than in the moderate asymmetry subgroup, and the amount of mandibular incisor compensation was positively correlated with Me deviation and mandibular yaw. Mandibular incisor compensation differed significantly between the roll- and yaw-dominant asymmetry groups. The yaw-dominant group demonstrated significant mandibular dental midline deviation, and dental compensation of the anterior teeth was positively correlated with Me deviation and mandibular yaw.

Severe Crowding Associated with Lower Canine Premature Resorption: Interceptive Treatment with Clear Aligners-A Pilot Study.

Early mixed dentition represents a critical phase since crowding conditions can occur. The interceptive resolution of dental crowding allows favorable arch and occlusal development. The aim of the present investigation was to evaluate dentoalveolar changes of clear aligner treatment planned to manage lower incisor crowding, loss of arch length, and midline deviation in early mixed dentition. A total of 13 patients (7 females, 6 males, 9.4 ± 1.2 age) treated with clear aligners were selected. Arch dimensions and incisor inclinations were evaluated before (T0) and at the end of interceptive treatment (T1). A paired t-test was chosen to compare T1-T0 changes. The level of significance was set at 5%. The greatest significant increase in mandibular width was observed at the level of the first deciduous molars (+2.44 ± 1.4 mm), followed by the second permanent molars (+2.16 ± 1.4 mm). Lower arch length and arch depth showed a statistically relevant increase (2 ± 0.6 mm and 4.5 ± 1.6 mm, respectively). The mean lower dental midline changes were statistically significant (1.42 ± 0.73 mm). Early treatment with clear aligners, including the combination of transversal arch development, maintenance of leeway space, and guidance of eruption, represents a valid treatment strategy in early mixed dentition to manage arch crowding and occlusion development.

Exploring Midline Asymmetry: A Comprehensive Study Among Adolescents in the North Bihar Population

Objectives In the contemporary era, achieving a sense of equilibrium is a paramount concern, and a visually pleasing smile is intricately linked to both professional success and social acceptance. Esthetics, with a specific focus on Oro-facial aesthetics, emerges as a primary motivation for individuals seeking dental treatment. Nevertheless, there exists an optimal and aesthetically pleasing range of dental midline deviation. The current study aimed to ascertain the prevalence of dental midline shifting and the average extent of midline discrepancy among adolescents (aged 13-17) from North Bihar population. Material &amp; Methods Two hundred subjects participated in the study, with 100 males and 100 females selected based on predetermined inclusion criteria. Intraoral frontal occlusion photographs were captured for each participant, and subsequent analysis was done utilizing Digimizer software. Statistical analysis was applied to the linear measurement data obtained through photographic evaluation. Results The study’s findings revealed a noteworthy proportion of subjects displaying deviations between upper and lower midlines and anterior teeth midlines, falling within the range of 0.03-3.80 mm. Conclusion The prevalence of these deviations was observed to be higher in males compared to females, and this difference was statistically significant.

Plagiocephaly and malocclusion

The term plagiocephaly means oblique head. Most skull deformities are a result of intrapartum or utero molding but can be caused by congenital torticollis and after birth due to persistent head position of newborns staying in one head position for a long time and abusive use of strollers, car seats, car seats, swings. Its prevalence is growing fast, in 30 years it passes from 1 in each 300 babies in early nineties to 16 to 48 % in 2020. The aim of this paper is bringing the light to some serious conditions of treatment protocols in individuals with plagiocephaly. The skull deformity causes facial asymmetry that are not treatable by orthopedic or orthodontic intra or extra oral appliances, nor orthognathic surgery. Well, despite the fact that the patient or the tutors have to be notified of the facial asymmetry that persists, functional limitations will be presented. In more than 30 years of clinical experience treating these patients it was never sought the 4 first permanent molars and the 4 canines in the same Angle’s Class. In one side can be seen Class 1, but on the other it will be finding class 2 or class 3, the case reported exemplifies it, and the worst, mastication guidance will have to be very carefully done since, in most cases if it is tried to adjust the inferior and superior dental midline the vertical asymmetry of the occlusal plane (minimum vertical dimension) will worsen. Really there is no unique treatment protocol and it has to be considered case by case. It is time to deepen the knowledge in this area since the prevalence is growing. Based on the case reported, non-treated plagiocephaly can bring serious limitations to malocclusion treatment results. Further studies are necessary to a better understanding of the situation plagiocephaly versus malocclusion.

Evaluating smile aesthetic satisfaction and related smile characteristics in dental students

AimThis study aimed to assess the association between self-rated smile satisfaction and the smile dimensions among dental students. MethodAn analytical cross-sectional study was conducted on 216 Vietnamese dental students. A standardized photograph was taken of each student with their frontal social smiles to assess aesthetic dimensions. A single-session self-administered questionnaire containing five questions about smile aesthetic satisfaction related to various aspects was administered to all students. Differences in smile characteristics and satisfaction scores between the two genders were evaluated. The impact of smile characteristics on satisfaction scores was assessed using multiple linear regression models. ResultsMost dental students had a high smile line, parallel smile arcs, an upward upper lip curvature, a non-touching labiodental relationship, a dental midline that coincided with the midline of the face, and eight teeth displayed during smile. Most participants were satisfied with their smiles, and the self-rated satisfaction score was 67 out of 100. Self-perceived overall smile satisfaction was associated with the "smile arc”, the "upper lip curvature”, the "number of teeth displayed during smile”, and the "dental midline”. Female students had a statistically significant correlation between self-perception and smile characteristics, such as upper lip curvature, dental midline shift, and smile line. ConclusionsThe smile arc, upper lip curvature, and dental midline shift affected self-perceived satisfaction among dental students. Female students showed an association between the smile parameters and self-perceived satisfaction.

Alignment of Maxillary and Mandibular Midlines in Dentate Individuals: A Cross-sectional Analysis

Introduction: The dental midline is a vital element in smile design. The maxillary and mandibular central incisors midline should ideally be positioned coinciding with each other, Incorrect placement of midlines would lead to instability in dental composition. The dental literature fails to disclose the data as to how nature positions the midline of anterior teeth. Aim: To evaluate the relation between the midlines of maxillary and mandibular dental arches in the dentate population using standardised digital photographs. Materials and Methods: This in-vitro cross-sectional study was carried out in the Department of Prosthodontics, Maharishi Markandeshwar College of Dental Sciences and Research, Mullana, Ambala, Haryana, India between June 2021 to December 2022. A total of 155 dentate subjects (102 females and 53 males) of this demographic area, all within the age group 18-45 years of age were selected for present study. Full-face standardised photographs of the subject’s frontal profile of occluding teeth in a retracted mouth were captured with a Digital Camera (Nikon D3200 DSLR). The collected samples of intraoral images were analysed in image analysing software (Digimiser version 6.0). Lines were constructed in the software to record the maxillary midline and mandibular midline to assess the coincidence or deviation between them. Direct measurements were also obtained within these constructed lines to record the distance of deviation. Direction (right/left) and distance of deviation were recorded. The collected data were subjected to appropriate statistical testing. The statistical analysis was done using the Chi-square test, t-test, etc., and performed in the statistical software International Bussiness Machine (IBM) Statisical Packages of Social Sciences (SPSS) statistics version 25 (Armonk, USA). Results: The mandibular midline did not coincide with the maxillary midline in 134 (86%) of the tested population and within both genders and showed a significant (p-value-0.00) deviation of 1.88 mm after application of the t-test. Although 78 (50%) deviations were towards the left-side and 56 (36%) toward the right-side of the maxillary midline within both genders, the results were statistically insignificant with the Chi-square test. Conclusion: Mandibular and maxillary dental midline fails to coincide in more than four-fifths of the subjects.

A patient with bimaxillary protrusion was treated by the extraction of four premolars and four compromised first molars: a case report

Abstract The first molar has been reported to be the most caries prone tooth in the permanent dentition. Rarely is the extraction of the four first molars the ideal choice in orthodontic treatment, especially the extraction of four molars and four premolars. However, the extraction program presents a treatment alternative in selected cases. In the following case report, the orthodontic treatment is described a 15-year-old male patient who presented with a dentoskeletal bimaxillary protrusion, and a chief complaint of”crooked teeth”. Moreover, the patient had a skeletal Class I malocclusion with crowded dentitions, a hyperdivergent growth pattern, deviated midlines and an extremely deep Curve of Spee. A satisfactory treatment outcome was obtained by the extraction of four premolars and four compromised first molars. The mechanics involved alignment, levelling, detailing the occlusion using a straight arch wire technique followed by retention. The active treatment time was 48 months. The treatment successfully achieved a bilateral Class I relationship of the canines and the right molars, a mild Class III relationship of the left molars, a normal overjet and overbite, aligned dental midlines, optimal intercuspation and a harmonious facial profile. The occlusion remained stable during 5 years of review.

Effects of sagittal split Ramus osteotomy on condylar position and Ramal orientation in patients with mandibular asymmetry.

The purpose of this study is to assess the impact of Sagittal Split Ramus Osteotomy (SSRO) on the alignment of the condyle and orientation of the Ramal segment following surgery in patients operated for the correction of mandibular asymmetry. A total of 27 patients who underwent SSRO were enrolled in this study, and study groups were defined as asymmetric (study group) and symmetric (control group) using linear measurements from the dental midline based on a three-dimensional coordinate system. Differences on preoperative and postoperative values of anterior (AJS), posterior (PJS) and superior joint spaces (SJS), condylar axial angle (CAA), Sagittal Ramal Angle (SRA), and Coronal Ramal Angles (CRA) of study and control groups were measured and compared. The data was analyzed using the "Wilcoxon signed-ranks test" to identify differences between groups. Differences between preoperative and postoperative values of CRA and SRA of the contralateral group showed statistically significant results with p-values of 0.007 and 0.005, respectively. A statistically significant change in CAA angle was found in the control and deviation groups (p = 0.018 and p = 0.010, respectively). SSRO has inevitable effects on the condylar and ramal orientation. Individuals with asymmetry require particular attention throughout the planning process and beyond. Conjunctive modalities and modifications should be considered and utilized when necessary. Future studies with larger sample sizes, homogenous follow-up periods, and more comprehensive clinical data are needed to substantiate understanding of the response of the condylar segment. Orthognathic surgeries inevitably alter the alignment and harmony of temporomandibular structures and may result in change of AJS, PJS, SJS, CAA, SRA, and LRA, which may change the biomechanics of joint and lead to several complications like temporomandibular disorders. Especially in cases with midline asymmetry needs special consideration from planning till the end of the treatment to achieve best results. In severe cases, conjunctive modalities and modifications and other alternatives such as inverted-L osteotomies should be considered.

The impact of dental midline angulation towards the facial flow curve on the esthetics of an asymmetric face: Perspective of laypeople and orthodontists.

The objective of the present article was to evaluate the ımpact of dental midline angulation in asymmetrical faces. A full-portrait image was used to create a set of digitally modified images with a different degree of facial asymmetry, towards the right and the left side of the face respectively. Half of the images were designed with an equivalent angulation of the dental midline in respect to the curve of the lower third of the face and half of them without. Through a web survey, 250 laypeople and 250 orthodontists were asked to assess the attractiveness of each image separately. As the asymmetry of the face was increased, facial attractiveness was further decreased both for laypersons and orthodontists. For each one of the modified images, when the dental midline was following the curve that was formed from the inclination of the simulated asymmetry of the face, the smile attractiveness scores were significantly higher compared to a straight dental midline. Facial asymmetries derived from the inclination of the nose, the chin and the commissural line of the lips can significantly affect the smile attractiveness. An orientation of the dental midline towards the facial asymmetry in order to follow the facial curve, can be beneficial for the smile attractiveness compared to a perpendicular to the face dental midline. During the design of a smile, clinicians have to take into consideration deviations in facial midline, in order their restorations to be in harmony with the rest of the face. During the design of a smile, clinicians have to take into consideration deviations in the facial midline, in order their restorations to be in harmony with the rest of the face.

Prevalence of malocclusion in adolescents according to sex, caries experience, gingival bleeding and smile dissatisfaction

Objective: The propose of this study was to estimate the prevalence of malocclusion among adolescents and to assess the differences of this prevalence according to sex, experience of caries, gingival bleeding, and smile dissatisfaction. Methods: A cross-sectional study was conducted with 600 adolescents from 10 to 16 years old, who were identified and selected from public schools’ records. Intraoral and extraoral examinations were performed following World Health Organization recommendations and included: number of decayed, missing and filled teeth, presence of gingival bleeding, and occlusal condition. The latter was assessed based on information of Dental Aesthetic Index, and Foster and Hamilton Index, in addition to the evaluation of dental midline, facial and smile pleasantness according to Capelozza Filho classification. Smile dissatisfaction was also evaluated. Bivariate Poisson regression with robust variance was used to compare prevalence rates. Results: The prevalence of malocclusion, caries experience, gingival bleeding and smile dissatisfaction were 96.0%, 52.3%, 55.8%, and 49.4%, respectively. The prevalence of malocclusion was higher among adolescents with gingival bleeding. Statistically significant associations were noticed between crowding of the upper and lower anterior teeth and gingival bleeding, as well as among Class III molar relationship, deviation of the dental midline, anterior open bite, anterior crossbite, and caries experience. Smiles classified as acceptable or unpleasant were associated with dissatisfaction. Conclusion: These findings have evidenced a higher prevalence of malocclusion among adolescents and its association with caries experience, gingival bleeding, and smile dissatisfaction.

Modification of surgical and positioning splint for orthognathic surgical treatment of facial asymmetry

Present short communication demonstrates innovative approach for surgical and positioning splint modification, which could improve accuracy of orthognathic surgery during facial asymmetry treatment. Usage of traditionally designed splint leads to the orientation of the midline based just on visual control, which inevitably associated with some level of maxilla deviation. It was proposed to design splint with mutually perpendicular planes in its’ frontal part at the specialized software. Such approach helps to align vertical plane of the splint with the midline vertical facial plane, while horizontal component could be aligned with the horizontal one accordingly. Proposed approach was approbated in five different clinical cases of facial asymmetry treated by orthognathic surgery. In all analyzed cases dental midline aligned perfectly with the planned one, in two cases the midline sagittal plane deviations (from ANS to PNS) resulted to be less than 2°. The horizontal occlusal plane deviations were considered clinically non-significant. Modification of the surgical splint for jaws positioning in orthognathic surgery treatment enables possibilities to check and control position of maxilla regarding reference facial planes intraoperatively, which in turn increases the accuracy of bone fragments placement and assure high precision of orthognathic surgery for asymmetric cases.

Idiopathic External Cervical Resorption of the Impacted Second Premolar: A Case Report

The tooth impaction of the lower second premolars is an occasional condition but is still seen in clinical practice with a prevalence of 0.6–2.6%. The present case report describes a rare condition of the lower second premolar impaction. An 11-year-old female patient presented with the anteroposterior dental discrepancy, midline shift, and occlusal cant. Intraoral examination revealed the absence of the lower right second premolar with no space available for the eruption. X-ray examination revealed the impaction of tooth #45 in a vertical position, tilting of the adjacent teeth, and two-thirds root length development. The orthodontic treatment plan included space opening using a fixed appliance with a coil spring. The natural eruption of the tooth was expected according to dental age and root development. When the space was opened, no change in the position of tooth #45 was observed. Surgical exposure and active traction were performed. However, the intrusion and tilting of adjacent teeth were observed during the next appointments with no vertical change of tooth #45. Ankylosis was suspected as no tooth movement was recorded. The surgical luxation and osteotomy of the coronal alveolar bone of the impacted tooth were planned for the imminent forced eruption, which was expected due to the young age of the patient. Consequently, the crown of tooth #45 emerged and the bracket was placed. Further traction was planned to use a micro-screw. Following the traction, no vertical displacement of the tooth was observed in the subsequent appointments. Radiographic examination revealed radiolucency in the coronal third of the root. The patient was referred to the endodontist, and CBCT revealed external cervical root resorption in the late reparative stage. ECR in an impacted tooth, mimicking the manifestation of tooth ankylosis, can cause orthodontic treatment failure.

Smile Aesthetics Assessment in Patients Undergoing the Finishing Phase of Orthodontic Treatment: An Observational Cross-Sectional Study.

Objective To describe the smile characteristics of patients entering the finishing phase of orthodontic treatment. Methods This observational study involved a non-probabilistic sample of 48 patients. Clinical records served as the basis for determining the type of treatment (with or without extractions). Photographs were analyzed to obtain smile variables. Dental casts and panoramic radiographs were evaluated to ascertain the cast-radiograph evaluation (CRE) index. Univariate and bivariate analyses were conducted at a significance level of 0.05. Results The study evaluated 24 men and 24 women, with an average age of 20.10 ± 6.78 years. Fifty percent of the patients did not undergo extractions, and the average CRE index for the sample was 34.83 ± 9.01. Regarding the smile, a medium smile line was prevalent in 66.7% of cases, and a non-consonant smile arc was observed in 58.3%. Significant differences in the smile arc were found between patients with and without extractions (p=0.019). Right and left buccal corridors measured 2.52 mm ± 1.52 and 2.43 mm ± 1.37, respectively. The upper dental midline deviated by 0.80 ± 0.91 mm and had an angulation of 1.65 ± 2.05º. Both variables showed significant differences between Class I and Class II patients (p=0.020; p=0.027). Symmetrical smiles were also observed (1.05 ± 0.17). Conclusions Based on our findings, clinicians should focus on the smile arc in patients who have not undergone extractions and on the midline inclination in Class II patients. These appear to be the most common areas for improvement in patients who are in the finishing phase of treatment. Additionally, considerable variability exists in the smile characteristics of patients still undergoing orthodontic treatment, leaving room for further enhancement of results.

ASSESSMENT OF ESTHETIC SMILE COMPONENTS BY DENTAL STUDENTS

Background: The present information indicates that most students utilized the technology-based system well, but they missed some practical activities. Assessment of students’ satisfaction with the e-learning activities and asking for feedback can help institutions to improve the know-how about e-learning practices. Hopefully, the sudden pandemic-related shift through modes of education will not be considered an unfavorable impact on education but an evolving experience to pave a comprehensive way to technology-based educational activities.Material and methods: The study was performed on 580 dental students. Among the eight components of the balanced smile, six factors (the smile arc, smile line, dark buccal corridors, gingival margin and incisal edge asymmetries, tooth axis, and dental midline inclinations) apart from those related to dental and gingival ones, were examined on photographs. Manipulations were made on the photo of a female patient with the ideal smile.Results: Statistically significant differences were observed between the preclinical and clinical groups and, in binary comparisons, between curricular years at pre-clinical and clinical levels (P &lt; 0.05).Conclusions: Our findings confirm the reports from previous investigations considering the impact of dental education on dental students’ perception of dentofacial esthetics.

Perception of facial and dental asymmetries and their impact on oral health-related quality of life in children and adolescents.

The aim of this study was to investigate the perception of facial and dental asymmetries in children and adolescents and how these asymmetries affect their psychosocial and emotional well-being. The study included 66children and adolescents (7-15years) with adeviation between the maxillary and mandibular dental midlines of > 0.5 mm. The soft tissues of the face were scanned using stereophotogrammetry. Psychosocial and emotional impairments were assessed using the German version of the Child Perceptions Questionnaire (CPQ-G8-10 and 11-14). The mean midline deviation of the study group was 2.3 mmwith no significant gender differences. Girls perceived facial asymmetry significantly more often than boys (p < 0.01). However, stereophotogrammetry showed no significant differences in facial morphology between subjects who perceived their face as asymmetrical and those who perceived it as symmetrical. Interestingly, we observed asignificant correlation between the deviation of the dental midline and the lateral displacement of gonion (p < 0.05) and cheilion (p < 0.01). Psychosocial and emotional impairment was significantly higher in girls than in boys (p < 0.05). However, there was no significant correlation with the measured facial asymmetries. In contrast, the CPQ subscale score was 2.68points higher in individuals with adental midline shift ≥ 3 mm (p < 0.01), independent of age and gender. Although girls perceived facial asymmetries more strongly than boys do, this perception could not be objectified by extraoral measurements. Amidline shift of 3 mm or more had anegative impact on the oral health-related quality of life of affected children and adolescents.