Harmonious Smile Research Articles

Three-dimensional stereophotogrammetric analysis of 50 smiles: A study of dento-facial proportions.

The purpose of this study was to analyze 50 smiles using 3D stereophotogrammetry (3D-spg)-based facial reconstruction, to calculate ratios involving measurements of the distances between dental and facial landmarks and to compare these ratios with the golden ratio φ (1.618). Fifty subjects with no obvious malocclusion participated in this study. For each subject, 4 photographs were acquired using the LifeViz Mini™, an absolute calibration 3D-spg system. Facial and dental landmarks (based on Farkas' definitions) were fixed, and 8 distances were measured. Four ratios were then calculated and compared with the value of 1.618. The ratio "incisal edge of the maxillary central incisor-lower border of the chin/subnasal point-incisal edge of the maxillary central incisor" (IE-Me/SN-IE) was 1.693 ± 0.190, the ratio "right endocanthion-left endocanthion/right exocanthion-right endocanthion" was 1.582 ± 0.173, the ratio "incisal edge of the maxillary central incisor-distal edge of the right canine/distal edge of the right canine-right labial commissure" was 1.670 ± 0.355, and the ratio "right labial commissure-left labial commissure/distal edge of the right canine-distal edge of the left canine" was 1.602 ± 0.136. In contrast, the vertical ratio IE-Me/SN-IE significantly differed from the golden ratio (1 sample t test, P = .009). This study revealed that the observed ratios were surprisingly close to the golden ratio. Only the vertical ratio differed from the golden ratio, whereas the horizontal ratios appear to be adequately approximated by φ. If the distances from reference points of the face to teeth within a harmonious smile exhibited recurring esthetic proportions, knowledge of such ratios would provide an additional tool for the elaboration of esthetic treatment plans. In addition, this knowledge could provide guidance when planning tooth positions and dental proportions by encouraging consideration of the global nature of the oro-facial sphere.

Correction of gummy smile prior to restorative procedures: case report

Techniques for aesthetic purposes are being frequently used in dental practice due to social context. These techniques can be used to correct concomitant disharmonies in smile. This clinical case aimed to provide a harmonious smile combining the techniques of gingivoplasty and direct veneers on the maxillary anterior teeth. Case report: The gingivoplasty with clinical crown augmentation sought to correct defects present in tooth-gingival anatomy, resulting in arealignment of the gingival contour. Conclusion: The direct veneer technique with composite resins was elected for closing the interincisal diastema and correction the size of the involved teeth, providing a more aesthetic dental anatomy.

Tratamiento estético con laminados cerámicos para cierre de diastemas. Relato de caso clínico.

The design, planning, performance and getting a harmonious smile brought an advance of Dental Materials, of clinical use and laboratory, and changes in esthetic restorative techniques. Diastemas are spaces between adjacent teeth which usually cause an esthetic discomfort of the patient. Ceramic veneers are a good alternative to offer the patient for a functional and harmonious smile with excellent optical properties. In addition to the biocompatibility with the tooth and gingival structure, color stability and durability of a long term, however, the execution of treatment with these material implications prior planning, aesthetic analysis of a through digital photography and smile Design, waxing diagnosis, Mock-up, Testing model, knowledge of material properties, domain the clinical preparation of tooth structure preserving healthy tissue through selective wear, in addition to the temporary restoration technique and protocol for cementation. This clinical report aims to present a technique of indirect restorative treatment with ceramic veneers for diastema closure in order to harmonize smile.

Bleaching and enamel microabrasion in the smile esthetics: a case report

The color change of teeth is frequent in the dental office and has important role in smile harmony. Objective: To discuss through case report the dental bleaching technique associated with enamel microabrasion to remove localized white spots on the maxillary incisors and canines. Case report: Patient, female, aged 18 years, attended the Clinic of the University of Ribeirão Preto complaining about the negative aesthetics of her smile due to the presence of white spots on teeth #13, #12, #11, #21, #22 and #23. After detailed anamnesis and clinical examination, the spots were diagnosed as enamel demineralization caused by cariogenic challenge occurred during the use of orthodontic brackets. Dental bleaching technique with 38% hydrogen peroxide was applied followed by enamel microabrasion with 6.6% hydrochloric acid and silicon carbide paste. After absolute isolation, 1 mm thick paste was applied on enamel stain with the aid of resin composite polishing abrasive rubber. Each application was followed by copious washing and analysis of the stain removal with wet enamel surface. In total, six applications of 10 seconds each were used. Finally, enamel polishing was executed with felt discs and diamond paste, and topical application of fluoride. Conclusion: It was concluded that bleaching associated with enamel microabrasion technique is a safe, simple, and effective option for solving the esthetics of teeth with white spots.

Paralysie faciale chez l’enfant

Facial palsy (FP) in children is congenital or acquired. When present at birth (congenital), etiologies are mostly traumatic and rarely developmental. Acquired FP needs investigation. Research on the etiology helps to determine prognostic and treatment. At most times, no specific cause is found. Treatment of idiopathic FP consists of early oral corticosteroid therapy and ocular protection. Treating the sequelae is essential and the physician has to consider the dynamic balance of both sides of the face. Dynamic rehabilitation should mainly concern the inferior facial third. We recommend the lengthening temporalis myoplasty (LTM). This relevant technique ensures replicable and reliable results with a harmonious smile. Facial dynamic rehabilitation after surgical procedure (muscle tranfer or free muscle flap) must be directed toward control of voluntary movement, to move from a mandibular smile to a spontaneous and voluntary smile, thanks to brain plasticity. Furthermore, botulinum toxin is well tolerated and remains a great tool to treat a child who can support injections.

MANEJO CLÍNICO MULTIDISCIPLINAR DA REABILITAÇÃO ESTÉTICA UTILIZANDO CERÂMICAS PURAS: REVISÃO DE LITERATURA

O anseio por um sorriso estético e harmônico eleva o nível de exigência e de expectativa do paciente devido o indivíduo estar inserido numa sociedade onde a aparência tem grande relevância na sua aceitação e autoestima. Dentro desse contexto, uma abordagem multidisciplinar para a reabilitação estética e funcional do sorriso foi inserida na Odontologia contemporânea, destacando-se tratamentos mais conservadores como o clareamento dentário, o aumento de coroa clínica, coroas e facetas cerâmicas por meio de materiais que mimetizem as estruturas dentais. O objetivo deste trabalho é apresentar uma revisão de literatura a respeito de reabilitações do sorriso em cerâmica pura, que se baseia em enceramento diagnóstico e planejamento reverso, uso de mock-up e fotografias, aumento de coroa clínica, clareamento, cimentação adesiva, com foco no resultado estético final. Um bom planejamento integrado, com a indicação correta, possibilita uma abordagem mais conservadora da estrutura dental, apresentando-se como excelente solução para alterações estéticas e funcionais do sorriso. Portanto, é indiscutível a importância do conhecimento por parte do profissional, sobre o material e sua técnica, para obtenção de um resultado satisfatório. Conclui-se que a reabilitação estética do sorriso ocorre a partir de uma multidisciplinaridade entre várias especialidades, que posteriormente a um planejamento integrado, permitem restabelecer o sorriso.

MANEJO CLÍNICO MULTIDISCIPLINAR DA REABILITAÇÃO ESTÉTICA UTILIZANDO CERÂMICAS PURAS: REVISÃO DE LITERATURA

The desire for an aesthetic and harmonious smile raises the level of demand and expectation of the patients, due to the individual being inserted in a society where the appearance is very important to their acceptance and self-esteem. Within this context, a multidisciplinary approach to the aesthetic and functional rehabilitation of the smile was added to the contemporary odontology, highlighting more conservative treatments like teeth whitening, the increase of clinical crown, crowns and ceramic veneers, using materials that mimic the dental structures. The objective of this paper is to present a literature review on the smile rehabilitation techniques using pure ceramics, which is based on diagnostic waxing and reverse planning, the use of mock-up and photographs, an increase of clinical crown, whitening, and adhesive cementation, focusing on the final aesthetic result. A good integrated planning, with the correct indication, enables a more conservative approach to the tooth structure, presenting itself as an excellent solution for aesthetic and functional modifications in the smile. Thus, it is unquestionable the importance of knowledge by the professional, about the material and the technique, to obtain a satisfactory result. It is concluded that the aesthetic rehabilitation of the smile occurs from multidisciplinary approaches within some specialties, which subsequently to an integrated planning may allow to restore the smile.

Diagnosis of Esthetic treament

To improve esthetics and gain beautiful smile, the maxillary anterior dentition is crucial. Through alteration of height, arrangement or color of the maxillary incisor, we can rehabilitate the esthetic smile. The perception of dental esthetics is highly subjective. Personal perceptions or judgement of dental esthetics is highly related with each individual's experience and social and cultural environment. However, there have been many efforts to establish the criteria for generally accepted esthetic norm, in order to increase the predictability of restorative treatment. For maxillary anterior restoration, not only a single tooth, but also the compositions around tooth such as facial form, lips and gum and their relationships have to be considered to create harmonious smile. It can be determined as esthetic restorations when in consonance with facial form and structures that frame the restorations. In this review article, several guidelines that are generally accepted and useful to assess the esthetics and communicate with patients and technicians will be discussed.

Esthetic Crown Lengthening Involving Dental Implants and Natural Teeth: A Case Study

Objective: This paper presents a rare management of excessive gingival display around dental implants and natural teeth using a minimally invasive approach to reduce peri-implant soft tissue with limited osseous reduction around natural teeth. It highlights esthetic crown lengthening procedure creating symmetrical gingival margins in the maxillary anterior region around dental implants and natural teeth. Clinical considerations: Excessive gingival display or gummy smile may adversely impact patient's appearance leading to esthetic concerns. Careful management of soft tissues around dental implants differs than that around teeth to achieve esthetic results. A technique is presented to esthetically and biologically align the gingival margins in areas of implants and natural teeth. It combines soft tissue reduction for implants with limited osseous and soft tissue reduction around natural teeth to achieve symmetrical results. Conclusion: Based on objectively evaluating the results using PES and WES parameters, esthetic results can be achieved around natural teeth and implants with excessive gingival display, through establishing a natural harmonious smile with stable outcomes at 24 months follow up

A Conservative Esthetic Approach Using Enamel Recontouring and Composite Resin Restorations.

Conservative clinical solutions, predictable esthetic, and immediate outcomes are important concepts of restorative dentistry. The aim of this case study was to recognize the selective enamel removal as an interesting conservative alternative to achieve optimal esthetic results and discuss the clinical protocol. This clinical report described an alternative esthetic and conservative treatment to transform the long and sharp aspect of the maxillary canines with a slightly aggressive aspect into features of slightly curved teeth with delicate lines. An accurate diagnostic and esthetic analysis of the smile was initially performed. The selective enamel removal was performed, and direct composite restoration was strategically placed. Clinical assessment showed good esthetic outcomes, enabling a smile harmony with an immediate, simple, and lower-cost technique. Practitioners should be exposed to conservative approaches to create esthetic smiles based on the selective enamel removal technique combined with composite resin.

REANATOMIZAÇÃO DENTAL COM RESINA COMPOSTA: RELATO DE CASO

Purpose: to present a case in which it was decided, as treatment plan, by bleaching followed by the preparation of semi-facet composite resin of the upper canines to return the dental anatomy. Case description: Male patient with a history of child bruxism, where the anatomical features of maxillary canines were lost, he seemed to be dissatisfied with the cosmetic appearance of your smile. The aesthetic resolution of this case was based on the bleaching employment and direct technique with the use of composite resin, to obtain a harmonious smile, observing the correct protocol based on the latest evidence presented in the literature, and the result has met the aesthetic expectations of the patient. Conclusion: Direct composite resin restorations are excellent for reshaping of anterior teeth, restoring and reproducing the shape, size and color of the teeth.

REANATOMIZAÇÃO DENTAL COM RESINA COMPOSTA: RELATO DE CASO

Objetivo: apresentar um caso clínico em que optou-se, como plano de tratamento, pelo clareamento dental seguido da confecção de semi-faceta em resina composta dos caninos superiores a fim de devolver a anatomia dental. Descrição do caso: Paciente do sexo masculino, com histórico de bruxismo infantil, onde foram perdidas as características anatômicas dos caninos superiores, mostrava-se insatisfeito com a aparência estética do seu sorriso. A resolução estética deste caso baseou-se no emprego do clareamento dental e da técnica direta, com a utilização de resina composta, para a obtenção de um sorriso harmônico, observando-se o protocolo correto baseado nas últimas evidências apresentadas na literatura, sendo que o resultado atendeu as expectativas estéticas do paciente. Conclusão: As restaurações diretas em resina composta são excelentes para a reanatomização de dentes anteriores, reabilitando e reproduzindo a forma, tamanho e cor dos dentes. Dente canino; Estética dentária; Materiais dentários.

Effects of transverse relationships between maxillary arch, mouth, and face on smile esthetics.

To identify the ideal ratios between the widths of the maxillary arch, mouth, and face, respectively, and to determine the range of acceptable esthetic variations based on these ideal ratios. A photograph of a young female with a harmonious smile was selected and digitally altered to produce two sets of images. The first image showed an altered intercanine width, while the second one showed an altered oral fissure breadth. These alterations were independently rated by judges, including 23 orthodontists and 30 undergraduates. The Mann-Whitney U-test was used to compare the scores given by male and female judges and those given by professional and nonprofessional judges. The following ideal transverse ratios were determined: intercanine width/oral fissure breadth, 0.638; oral fissure breadth/interparopia width: the distance between left and right paropia, 0.617; and intercanine width/face width at the level of the labial commissures, 0.300. A range of -10% to +10% was proposed as the thresholds of esthetic smile evaluations. It was shown that gender of the raters had no effect on the rating of photographs, nor were there any statistically significant differences between the professional and nonprofessional judges' ratings. Balanced transverse relationships in the facial region are important for smile esthetics, and there is a wide range of esthetically acceptable variations in the transverse relationships between the maxillary arch, mouth, and face.

Management of excessive gingival display: Lip repositioning technique

The lips form the frame of a smile and define the esthetic zone. Excessive gingival display during smile is often referred to as gummy smile. A successful management of excessive gingival display with lip repositioning procedure has shown excellent results. The procedure involves removing a strip of partial thickness mucosa from maxillary vestibule, then suturing it back to the lip mucosa at the level of mucogingival junction. This technique results in restricted muscle pull and a narrow vestibule, thereby reducing the gingival display. In this case gummy smile was treated by modification of Rubinstein and Kostianovsky's surgical lip repositioning technique which resulted in a harmonious smile.

Nonextraction management of the labially displaced canine

Maxillary canine impaction is an anomaly often encountered in children. Although it has been reported that the incidence of palatally impacted canines is higher than that of labially impacted ones, it has been found that labial impaction of canines is more common than palatal impaction in Asian populations. Bringing the ectopic canine into a normal position is important for functional occlusion and the final esthetics of the orthodontic treatment. This article represents a nonextraction treatment approach for a labially displaced canine of a young boy, aged 12 years 6 months, with maxillary transverse discrepancy, labially placed maxillary canine, cross bite with UL3, UL4, UL5, midlines discrepancy, severe crowding in mandibular arch. The orthodontic treatment plan included slow palatal expansion followed by fixed orthodontics which guided the maxillary canine into the arch. This treatment strategy achieved optimal occlusion with improvements to the transverse, vertical, and sagittal relationships and achieved a harmonious smile.

Indications and experience with counterclockwise rotation of the maxilla- mandibular complex

In orthognathic treatment planning for the correction of dentofacial deformities imaging and planning are important steps prior to surgery. Based on the natural head orientation, the anterio-posterior and vertical position of the upper incisor tip is one of the key elements in aesthetic planning. Gum exposure and facial and smile harmony are factors that influence this position. After definition of the upper incisor tip position, the maxillomandibular complex (MMC) can be altered according to the treatment needs (severe class II deficiency, reduced airway space etc.). Depending on the pivot point and the amount of rotation of the MMC, the hard and soft tissue changes can vary. Placement of the pivot point anteriorly (anterior nasal spine or upper incisor tip) results in an increase of the posterior face height and in extensive advancement of the lower face (up to 25 mm). In contrast, placement of the pivot point posteriorly reduces the anterior face height and has limited effect to the lower face profile. The advancement of the lower face is influenced by the location of the pivot point, the amount of rotation of the MMC (up to 5 degree), the amount of overjet corrected with sagittal split osteotomy and the amount of advancement of genioplasty. Careful analysis of the cephalograms and the face and implementation of these data into the planning are important to optimize occlusal function and facial aesthetics after orthognathic surgery. The concept of rotation of the MMC in either way widens the spectrum in treatment planning.

Management of occlusal canting with miniscrews

A 14-year-old boy with a skeletal Class II malocclusion and open bite whose chief complaint was a posterior crossbite showed a canted occlusal plane with asymmetric gummy smile and mandibular deviation at clinical examination. The treatment with miniscrews focused on the bilateral intrusion of the maxillary posterior teeth and, after resolving the open bite, a new biomechanical technique involving joined miniscrews was applied for an en masse intrusion of the left side. This treatment strategy achieved optimal occlusion with improvements to the sagittal, vertical, and transverse relationships and achieved a harmonious smile.

Analysis of smile esthetics in American Board of Orthodontic patients

To investigate the common denominators of an esthetically pleasing smile in patients who were considered to be successfully treated upon the submission to American Board Orthodontics (ABO) clinical examination. A total of 462 patients were examined. Ninety subjects that fulfilled the inclusion criteria were included. Standardized digital smile photographs of the subjects were rated by 30 panel members, including orthodontists, general dentists, and parents of orthodontic patients, using a numeric version of the visual analog scale. Three groups were formed using the mean esthetic score±standard deviation range: unattractive (n=21), average (n=47), and attractive (n=22) smiles. Eleven smile characteristics were digitally measured on the photographs and compared between the groups using one-way analysis of variance and χ2 tests. Additionally, regression analyses were used to investigate the association of the smile characteristics with the esthetic score. A significant difference was found between the three groups for the comparison of smile arc relationship (P<.001). When all the variables used in this study were entered in the regression analysis, a positive association was found (r=0.658; r2=0.434; P<.001). Additionally, two models were defined using stepwise regression. The first model included the smile arc (r=0.478; r2=0.228; P<.001), and the second model had both the smile arc and right gingival display/visible dentition display ratio (r =0.567; r2=0.321; P<.001). A harmonious smile arc relationship and less gingival display during a smile are significantly associated with smile attractiveness in patients considered successfully treated according to ABO standards.

Challenges in reconstructing an isolated anterior tooth with a metal-free crown

Introduction: Currently, new esthetic treatments are available to the dentist due to the advent of ceramic-ceramic prostheses. A new option has become part of daily clinical practice, with the promise of esthetic optimization through the elimination of metal in prosthetic crowns. The translucence of these new systems allows the transmission of light through the tooth structure, minimizing gingival darkness and producing a vibrant and natural appearance. Case Report: The patient, 30 years old, female, showed with a fractured tooth crown at the cervical level in the right lateral incisive. It was observed that the tooth had prior adequate endodontic treatment. A metal-free restorative system was selected. A plaster model was obtained for subsequent tooth preparative scanning and manufacture of ceramic framework. After receiving the framework, adjustments were made and the color choice of covering ceramic, following the protocol of choice for a chroma suboptimal aiming further characterization. After the ceramics application, adjustments in shape, texture, and occlusion were made. The crown was characterized by exterior paint, getting a favorable result, restoring esthetics and function. Discussion : The metal-free systems are a viable alternative to the restorative treatment when esthetics is desired, allowing a natural and harmonious smile, combined with the reliability of the restorative material.

A modified technique that decreases the height of the upper lip in the treatment of gummy smile patients: A case series study

Delayed passive eruption is conventionally treated with osteotomy and osteoplasty, which is limited to the vicinity of cementoenamel junction. The aim of the present study was to evaluate clinical outcome of three gummy smile patients with delayed passive eruption submitted to an extended osteoplasty in the buccal aspect of anterior maxilla. Digital photograph images of maximal smile were taken in order to assess the results before and 9 months after surgery. All maxillary incisors were evaluated. In comparison with baseline, all patients presented lip dropping (calculated in 7.9 ± 1.7%), increase in crown length (18.2 ± 2.7%), and a decrease in the gingival display (46.6 ± 2.7%). On the other hand, considering specifically the decrease in gingival display, 19.7 ± 3.8% of it was due to the amount of lip dropping, while 26.9 ± 1.2% was due to the increase in crown length. Within the limits of the present study, it could be concluded that after the extended osteoplasty, upper lip has slightly dropped and was less tensioned, which provided a more harmonious smile. Key words: Gum, smiling, osteoplasty, mucogingival surgery, aesthetics.