Smile Esthetics Research Articles

Surgical-orthodontic Treatment of Skeletal Class III Malocclusion and Concomitant Open Bite: A Case Report

Surgical-orthodontic treatment for the correction of skeletal Class III malocclusion and concomitant open bite is challenging due to the probability of postsurgical relapse. The present case describes successful surgical-orthodontic treatment for the correction of Class III malocclusion with anterior and posterior open bite. Treatment consisted of the use of an Edgewise fixed appliance (0.022” × 0.028”) and bimaxillary orthognathic surgery. Treatment resulted in bilateral Class I molar and canine relationships, normal overjet and overbite, the correction of anterior and posterior open bite, alignment of the midlines, leveling of the curve of Spee, satisfactory facial harmony, and passive lip seal. The correct diagnosis as well as the proper indication and execution of orthodontic and surgical treatments enabled the achievement of satisfactory functional and facial results and smile esthetics.

Non-extraction camouflage treatment using extra-alveolar skeletal anchorage

Abstract A 23-year-old female patient with moderate crowding and a bilateral molar scissor-bite was successfully treated without tooth extraction. Extra-alveolar skeletal anchorage, involving a three-dimensional key plate in the maxilla and two miniscrews in the buccal shelf of the mandible, were used for distalisation, buccolingual uprighting, and the intrusion of molars by fixed orthodontic appliances. Cone-beam computed tomography was used to identify available posterior space for the distalisation and buccolingual correction of the molars in scissor-bite. The total treatment time was 24 months. Post-treatment results showed good occlusal relationships and smile aesthetics. Twelve-month post-treatment records demonstrated no significant relapse and a favourable facial balance.

Microinvasive esthetic approach for deep enamel white spot lesion

The white spot lesion on the dental enamel is an optical alteration that compromises the esthetics of smile. It can be caused by many factors, among them, defects in mineralization and formation of tooth enamel. Resin infiltrants are agents that penetrate, by capillarity, through the pores of the demineralized or hypomineralized enamel, altering the refractive index (RI) of the tooth structure and totally or partially masking the appearance of the white spot. The aim of this work was to report the use of resin infiltration to minimize the visualization of white spot lesion, present in an upper central incisor, as a microinvasive approach for the esthetic treatment of deep enamel hypomineralization. A 20-year-old female patient sought care with the esthetic complaint of extensive white spot lesion on the buccal face of her upper right central incisor. The diagnosis established was a deep white stain associated with the incisor molar hypomineralization syndrome, and the treatment of choice for the resolution of the case was the application of the Icon® resin infiltrant (DMG, Hamburg, Germany). To reach the body of the lesion, three cycles of acid erosion, using 15% HCl, were necessary to obtain a satisfactory aspect of masking the white lesion. A camouflage effect of the deep white spot lesion was achieved with the use of the resin infiltration, without the need of additional and irreversible wear of the dental structure.

Smile Arc Esthetics in Middle-Aged Man from the Layperson’s Perspective Via Eye-Tracking

Objective: To evaluate the perceptions of smile esthetics associated with variations in the vertical plane of the maxillary incisors in the smile arc using eye-tracking software. Material and Methods: An image of a 59-year-old Caucasian male model was adapted and edited to make three changes in the vertical plane, simulating a convex, straight, and reverse smile arc. Four areas of interest were inserted at the right and left eyes, nose, and mouth. Forty laypeople raters between 18 and 45 years of age participated of the study. Eye-tribe hardware and Ogama software were used to perform eye-tracking. Attractiveness and age-perception questions were also incorporated into the study. ANOVA test and Pearson’s correlation coefficient, at p < 0.05. Results: The most observed AOI in images with convex, straight, and reverse smiles, as assessed using heatmaps and point maps, was the mouth, followed by the right eye. A significant difference for the eye (p=0.02) was found when comparing convex and reverse smiles, whereas a significant difference for the mouth was observed between the straight and reverse smiles (p=0.03). Conclusion: Convex and straight smile arcs were associated with equal levels of attractiveness; the reverse smile was less attractive. No significant difference was noticed regarding age perception and the smile arcs. However, the reverse smile recorded a more complete fixation time.

Gender-based evaluation of positional variations of gingival papilla and its proportions: A clinicoradiographic study.

Background:The proportionate presence of natural teeth, gingival tissues along with the interdental papilla (IDP) is critical components of an esthetic smile. Hence, the present study examined the IDP height (PH), its position clinically and radiographically as papilla proportion (PP) and crestal PP (CPP).Materials and Methods:The study included 120 patients with healthy periodontium with an age group of 20–40 years, equally divided as males and females. The maxillary anterior interdental sites from canine to contralateral canine were examined for PH, PP, crestal PH (CPH), and CPP.Results:The mean values of PH, PP, CPH, and CPP were found to be greater on the mesial aspects of all the teeth as compared to the distal aspects. The females exhibited overall higher values than males for all the parameters. Majority of the teeth exhibited statistically significant differences for PP on mesial aspect when compared based on gender with mean values of 44.58% ±3.35% (males) and 47.17% ±3.23% (females) (P < 0.0001) for central incisor (CI). The CPP on mesial aspect for CI was 50.57% ±3.51% (males) and 54.21% ±3.76% (females) with P < 0.0001. A similar trend was followed in other teeth.Conclusion:The maxillary anterior teeth exhibit greater values on mesial aspects for parameters such as PH, PP, and CPP in both the gender thereby indicating an apical positioning of the IDP tip on distal aspect when compared to mesial. Furthermore, the values and differences were more pronounced in females than the males.

An Overview of Digital Smile and its Use in Aesthetic Dentistry

The idea of beautiful aesthetic smile dates back into history and has evolved further over the recent decades. The transition of smile design from 2-dimension approach to three dimensions approach was introduced in the last two decades and in recent times has shifted completely to computer aided digital smile design. The use of digital smile design helps the patient to visualize the outcome of treatment prior to the initiation thus yielding better satisfaction. The purpose of this research is to review the available information about digital smile and its use in aesthetic dentistry. Patients concerned with improving their smile are taking keen interest in the field aesthetic dentistry. Various digital smile design software is available and used in clinical practice. Digital smile design involves patients in the process of designing their smile formats, which leads to customizing smile based on individual needs and desires. It may be necessary to better encourage patients to recognize the aesthetic aspects and improve their knowledge of the smile design to obtain additional results. The digital smile design opens many opportunities for teaching, learning, and practice. Literature reveals that application of digital smile in aesthetic dentistry results in effective patient outcomes as it not only aids the patient in visualizing his treatment but is also helpful tool for dentist in treatment planning and management however, more clinical studies in future are needed to highlight the impact of digital smile design in the field of aesthetic dentistry.

Minimally Invasive Restoration of Fractured Maxillary Central Incisors with Partial Laminate Veneers- A Case Series

Porcelain laminate veneers are one of the most preferred treatment methods today, due to the increasing interest in minimally invasive approach and their superior aesthetic properties. With the appreciation of the minimally invasive approach and the developing adhesive procedures, the partial laminate veneers have become more popular in dental field. In these case series, the teeth were restored with partial laminate veneers by only intervening in the fractured area. In this case series, the teeth that were restored with partial laminate veneers were prepared with different techniques. Preparation was performed without bevel in enamel margin in the case 1, with incisal overlap and bevel to create more natural transition on tooth surface in the case 2. In the case 3, preparation with incisal overlap was performed with preparation of the palatal surface of the tooth. The optical impression was made with the digital camera of the Chairside Economical Restoration of Esthetic Ceramic (CEREC) acquisition unit (Omnicam CEREC Sirona, Bensheim, Germany), in the first case. In the other cases, impression was taken with elastomeric impression materials. In addition, restorations were fabricated from feldspathic porcelain and lithium disilicate porcelain. In all the cases, restoration was cemented with resin cements. The following cases present the minimally invasive treatment of maxillary central incisors with a partial laminate veneers fabricated from different ceramic materials. New materials, procedures, and techniques provide patients an improved quality of life and a greater self-esteem with creating a confident aesthetic smile.

Aesthetic dentistry as an integral component of facial aesthetics

With the appearance of the first signs of aging on the face, including wrinkles, we begin to think about our external appearance in terms of its aesthetics and attractiveness. The aesthetics of the face is one of the components of health, so in the process of evaluating the aesthetics of the face it is essential not to omit a very important aspect, namely the condition of the oral cavity and teeth. Therefore, when thinking about aesthetic medicine, it is worth consulting a dentist to assess the condition of the mouth, check the muscle tone, bone health, proper occlusion, missing teeth or tooth decay. Interdisciplinary dental treatment including restorative dentistry, periodontics, dental surgery, orthodontics, prosthodontics and sometimes maxillofacial surgery can be a prelude to facial aesthetic medicine treatment. A beautiful, aesthetic smile is not only a smile without signs of aging, but especially one resulting from healthy oral cavity.

Lip length and its correlation among different age group and gender in Nepalese Population

Introduction: The Dentofacial composition includes the lips and the smile as they relate to the face which provide the valuable information to the clinician when evaluating smile esthetics. Aims and objectives: To determine the relation of lip length and incisor visibility during rest and smile among different age groups and gender. Materials and Method: A cross sectional study was done in 158 participants of age group between 19-40 years and above. They were seated in an upright position at rest. Then the lip length was recorded with a calibrated digital caliper measuring from subnasale to stomion superius and categorized into short, normal and long lips. Similarly maxillary incisor visibility was observed on rest and during full smile. The data obtained were then analyzed with SPSS software (version 22) and student- t test and ANOVA test was used to compare the measurements. Results: It has been found that there is no significant of lip length in relation to gender and different age groups. Whereas average lip length has been found to be 21.2±2.3mm in male and 19.4±1.9mm in female. On the other hand significant difference is found in incisor visibility in different age groups and gender during smile. Conclusion: Within the limitation of the study, a significant difference has been found in the incisor visibility when compared between gender and age groups in full smile whereas there is no difference in the lip length in male and female group.

A Study on the Change of Perception to Smile Esthetics in Orthodontic Patients

A Study on the Change of Perception to Smile Esthetics in Orthodontic Patients

Application of Visagism Concept to Assess the Co-Relation between the Temperament and Smile Esthetics: A Clinical Study

Background: Ability of a person to express a wide range of emotions with the movement of teeth and lips is called as a smile. Dentogenic concept considers gender, personality, age in harmonizing shapes of teeth with the face. Personality is unique for an individual. Unveiling personality traits, desires of the individual, translating them into natural tooth shapes to maintain the psychodentofacial harmony poses a major challenge to the clinician in designing a smile. Visagism is a novel concept that helps the dentists in providing restorations that involve esthetics psychological and social features of the created image, which influences the individual’s emotions. It involves the customization of an image.&#x0D; Aim and Objectives: To assess the co-relation between the smile esthetics and mental temperaments or personalities through the application of the concept of visagism.&#x0D; Methodology: A Digital camera (DSLR) for capturing the photographs and smile designing software will be used. Each subject will be instructed to occlude the teeth while capturing photographs. A validated questionnaire study will be conducted that will help to discover temperament of the subject. The answers will be evaluated and maximum score of the responses out of the list will be dominant temperament in that individual.&#x0D; Expected Outcome: Co-relation between this study might help clinicians to accurately assess the correlation between the temperament and the smile esthetics and eventually develop proper customisation of a smile with respect to the personality of the patient.&#x0D; Conclusion: If computer-assisted smile design and application of visagism concept would be accurate and reproducible, this might help and improve the planning of smile designing, the oral rehabilitations.

Smile Aesthetics Acuity of Lay-persons verses Dental Professionals

Objective: To compare and evaluate the perception of smile aesthetics by lay-persons and dental specialists. Study Design: Cross-sectional study Place and Duration of Study: Department of Orthodontics, Bacha Khan College of Dentistry/Medical Teaching Institute, Mardan from 1st April 2020 to 31st July 2021. Methodology: Eighty participants were assessed for their smiles through photographical imaging to assess each photographic image of smile (frontal view) and categorized them as very good, good, average or bad. Results: The mean age was 20.59±3.1 years with 59 females and 21 males. The laypeople assessed smile under categories of very good (60%) or good with a least number of people categorizing it average or bad. Contrary to this the dentist perception about smile aesthetic was completely reveres. Conclusion: There is an obvious variance between perception of laypeople and dentists with dentist being more analytical and judgmental. Key words: Incisors, Smile, Aesthetic, Smile arc

Perception about Importance of Buccal Corridor and its Width in Smile Esthetics

Aim: To assess the perception of dental students and house officers regarding role of buccal corridor in smile esthetics and to determine the most esthetically pleasing buccal corridor width. Methods: A photograph of the patient’s face, smiling with the teeth visible up to the first molar was modified digitally to create smiles with no buccal corridor, increasing buccal corridors widths of 5%, 10%, 15%, 20 % and 25% respectively compared with the width of inner oral commissure. A total of 376 dental students and HOs participated in the study and data was collected in questionnaires. Results: Buccal corridor is considered to affect the smile esthetics of an individual by 72.4% of house officers, 67.6% of second year students, 48.7% of 3rd year students and 52.4% of fourth year students(P value: 0.002). Visibility of around 5-10% of buccal corridor was considered most esthetically pleasing, however, the result was not significant. Conclusion: Buccal corridor is an important component in smile esthetics considered by students and house officers of dental colleges. Buccal corridor width of 5-10 % was considered most esthetically pleasing among participants. Keywords: Buccal corridor, Esthetics, perception

Regenerative Endodontic Procedure as a Retreatment Alternative for Permanent Maxillary Central Incisors with Esthetic Smile Correction

Regenerative Endodontic Procedure as a Retreatment Alternative for Permanent Maxillary Central Incisors with Esthetic Smile Correction

Perception of The Aesthetics of a Smile in Patients Post Using Orthodonic Treatment Based on Characteristics

Aesthetics is a philosophy of the concept of beauty which is the reason people takeorthodontic treatment. One of the factors that influence aesthetics is a smile. Apartfrom personal experiences and social environment, the patient's perception of theaesthetics of the smile after orthodontic treatment can be influenced bycharacteristics. This study aims to determine the perception of smile aesthetics inpost-orthodontic patients based on characteristics. This type of research isdescriptive analytic with cross sectional design. The study population were patientswho were recorded in medical records at the practice of drg. Josep Ginting, Sp. Ortin Pontianak, West Kalimantan Province with a sample size of 30 people. Collectingdata by distributing questionnaires containing nine aesthetic indicators of smilesthrough the WhatsApp application. Data were analyzed using the Mann Whitneytest. Based on the results of the study, it was seen that there were differences inthe aesthetic perceptions of respondents' smiles based on age (p = 0.017), gender(p = 0.004) and education (p = 0.015). The conclusion of this study is that there aredifferences in patient perceptions of aesthetic smile after orthodontic treatmentbased on the characteristics in the practice of drg. Josep Ginting, drg, Sp. Ort inPontianak, West Kalimantan.

Smile esthetics in orthodontic: A review article

In orthodontic treatment, esthetics has traditionally been associated with profile enhancement. Both the Angle classification of malocclusion and the cephalometric analysis have focused attention on the profile, without considering the frontal view. Even though patients come to us mainly to improve their smiles, the orthodontic literature contains more studies on skeletal structure than on soft-tissue structure, and the smile still receives relatively little attention. An attractive, well-balanced smile is a paramount treatment objective of modern orthodontic therapy. Extensive studies on facial features have resulted in the establishment of norms that orthodontists use as guidelines to evaluate facial forms and to direct therapy. Knowledge of the influence of orthodontic treatment on smile attractiveness is very important, and recently, some smile components such as midline position, axial midline angulation, buccal corridor, and smile arc have received greater attention.

Clinical expression of programmed rotation and uprighting of bilateral winged maxillary central incisors with the Invisalign appliance: A retrospective study

Winged maxillarycentral incisors (WMCI), defined as mesiopalatal rotation of the crowns of maxillary central incisors, is a common dental trait that affects smile esthetics. This retrospective study aimed to determine the efficacy of rotation and uprighting tooth movements of bilateral WMCI with Invisalign (Align Technology, Santa Clara, Calif). Initial, predicted, and achieved stereolithography files of 30 adult patients, consecutively treated with the Invisalign SmartTrack appliance, were superimposed using Geomagic Control X 64 (3D Systems, Rock Hill, SC). The pairs of incisors were assessed for rotation using the interlabial angle (ILA), and individual incisors were measured for rotation and tip. Programmed rotation and uprighting of WMCI are mostly undercorrected with the Invisalign appliance. The mean shortfall in ILA was 10.5° (standard deviation [SD], 10.66; 95% confidence interval [CI], 5.89-14.19; P<0.001) for a mean predicted change of 35.27°. For individual incisors, a mean shortfall of 5.38° (SD, 5.88; 95% CI, 3.58-6.76; P<0.001) was found for a mean 18.75° predicted change in rotation. A mean predicted change in tip of 7.06° showed a mean shortfall of was 2.16° (SD, 3.86°; 95% CI, 1.03-3.01; P<0.001). A moderate and statistically significant correlation between shortfalls in rotation and tip was observed (r=0.44). Linear regression analysis was used to formulate an equation as a clinical tool to determine the likely achieved outcome on the basis of the predicted change. Predicted changes in rotation, ILA, and tip were both under and overexpressed. In particular, tip was dependent on the magnitude of planned change. The random inconsistencies in the clinical expression of rotation and tipping warrant careful monitoring and/or remedial actions such as overcorrections aligners.

Effect of Buccal Corridors Width on Smile Quality and Esthetics

OBJECTIVE: To assess the perception of buccal corridor width on smile esthetics by Orthodontic residents, General dentists and Laypersons. METHODOLOGY: A smile photograph was taken of an adult female. The image was modified to obtain five different buccal corridor widths and were assessed by different evaluators grouped into general dentist, orthodontic resident and laypersons who rated the attractiveness of each smile by means of a visual analog scale (VAS). Sample size was 97 participants to rate the picture. Non-probability purposive sampling was done The data was analyzed and mean and SD were calculated for the scores of rating. ANOVA and Tukey's post hoc test was applied to compare the different ratings of buccal corridors in three groups. The data of this cross sectional study was collected from general population belonging to different communities, general dentists and orthodontic residents of different dental colleges of Karachi, Pakistan from August 2019 to March 2020. RESULTS: There were 97 participants who responded to the images. Highest scores were obtained for Image 1 having buccal corridor width ratio of 16% followed by image no. 3 having buccal corridor width ratio of 10% and lowest scores were obtained for Image no. 6 having least buccal corridor widths ratio that is 34% followed by image no 5 having 26% buccal corridor widths. Among the groups of participants, the highest scores were given by laypersons for all images. Significant differences were observed between evaluation of groups of Orthodontic resident and layperson in most images. CONCLUSION: There was a remarkable influence of buccal corridor width on smile esthetics, with the 16% ratio group being rated as the most attractive by all three groups. KEYWORDS: Buccal corridors, Smile, esthetics, Attractiveness

Smile microesthetics as perceived by dental professionals and laypersons.

To evaluate and compare the perception of different dental professionals and laypersons toward altered gingival characteristics (microesthetics) and to identify those characteristics that are most negatively and positively rated. A smiling photograph of a female dental student was selected and digitally manipulated to create changes in different microesthetic parameters. These altered images were rated by the following five groups: 120 orthodontists, 45 periodontists, 49 prosthodontists, 130 general dentists, and 172 laypersons. Smile esthetics scores were calculated, and comparisons between groups were performed using the univariate general linear model. The presence of black triangles between the upper incisors was the most negatively rated, and the ideal smile was the most positively rated. Significant differences were detected in the rating scores among the different study groups (P < .05). Orthodontists, prosthodontists, and general dentists scored the presence of a black triangle in the smile as the least attractive, whereas periodontists and laypersons perceived the inflamed gingiva and pigmented gingiva as the least attractive, respectively. Dental specialists tended to give the altered smile images lower scores than the laypersons. The ideal smile and that with black triangles between the upper incisors were rated as the most and the least attractive smiles, respectively. Orthodontists, prosthodontists, and general dentists scored the presence of black triangles in the smile as the least attractive, whereas periodontists and laypersons perceived the inflamed gingiva and pigmented gingiva as the least attractive smiles, respectively. Dental specialists tended to give the altered smile images lower scores than the laypersons.

Effect of anterior overbite malocclusion on smile esthetics in adult patients.

ObjectiveTo investigate whether overbite affects smile esthetics.MethodsThis study involved 106 patients with complete pretreatment records. Lateral cephalometric tracings were used to measure hard tissue variables. Frontal smile and upper occlusal photographs were used to measure nine smile esthetic variables: arc ratio, number of teeth, upper incisor exposure, upper midline, buccal corridor ratio, smile index, archform index, lower teeth exposure, and interlabial gap. The patients were classified into three groups according to their overbites (B1: 0–4 mm, B2: >4 mm, and B3: <0 mm). Analysis of variance was performed to compare 14 cephalometric measurements and the 9 smile esthetic variables. Multiple linear regression analysis was performed to determine the influencing cephalometric factors.ResultsOnly upper incisor exposure was significantly different among the groups. In the multiple linear regression analysis, upper incisor exposure was positively associated with the distance from the upper incisor to the palatal plane in Group B2. No significant correlations were observed between cephalometric measurements and smile variables in Groups B1 and B3.ConclusionsSmile variables were not significantly different among patients with various overbite malocclusions with the exception of upper incisor exposure. Overbite malocclusions do not appear to influence smile esthetics in adult patients.