Ideal Smile Research Articles

Small tissue, big issue

One of the most important parts of an ideal smile is the presence of healthy gingiva. Gingival replacement is often a component of comprehensive prosthodontics. Gingival replacement prostheses have historically been used to replace lost tissue when other methods (e.g., surgery or regenerative procedures) were considered unpredictable or impossible. With this method, large tissue volumes are easily replaced. Gingival prostheses take several forms, and various authors have described their uses and methods of construction. Tissue replacement prostheses may be used to replace tissue lost through surgical gingival procedures, trauma, ridge resorption, or traumatic tooth extraction. From a prosthodontic point of view, restoration of these areas can be accomplished with either fixed or removable prostheses. Gingival prostheses may be made from acrylics, composite resins, silicones, or porcelain-based materials. Undercuts or dental attachments are used to secure removable prostheses, which are esthetically pleasing and easy to maintain. Healthy gingival tissues affect the esthetics, probably much more than teeth, a factor which is most often neglected in esthetic treatment planning. Periodontal flap surgeries often leave open embrasure spaces which are a huge esthetic deficit for the patient. This case report describes the use of a gingival prosthesis fabricated by valplast - a flexible nylon-based material to recreate the lost soft tissue esthetics.

Relationship between Perception of Maxillary Midline Diastema and Personality Profiles

ABSTRACT Aims The aim of this study was to investigate the relationship between personality profiles and perception of maxillary midline diastema (MMD) among laypeople. Materials and methods Hundred total of 200 laypeople (100 females and 100 males, mean age = 28.8 ± 5.5 years) were recruited in this cross-sectional study. They were asked to rate the attractiveness of two digital photographs of ideal smile with 1 and 2 mm MMD on a visual analog scale (VAS) from 0 to 10. Participants' personality and psychological profiles were assessed via neuroticism.extraversion.openness five-factor inventory. The statistically significant levels were set at p ≤ 0.05. Results The mean VAS scores were 5.7 (± 2.1) and 4.3 (± 2.0) for 1 and 2 mm MMD respectively. The participants rated the attractiveness of 1 mm diastema better than the attractiveness of 2 mm diastema (p < 0.001). Females showed no difference in rating diastema attractiveness in comparison with males (p > 0.05). Participants (from both genders) with higher neuroticism scores rated 1 and 2 mm diastemas as less attractive than those with lower neuroticism scores (p ≤ 0.001). Conclusion Psychological profiles (high neuroticism) might be associated with negative perceptions of attractiveness of MMD. How to cite this article Al Nazeh AA. Relationship between Perception of Maxillary Midline Diastema and Personality Profiles. World J Dent 2016;7(2):59-63.

Influence of Smile Arc and Buccal Corridors on Facial Attractiveness: A Cross-sectional Study.

Two aspects of the smile: the Smile Arc (SA) and Buccal Corridors (BC) have been the interest of the orthodontist in recent years. The present study was undertaken to evaluate the influence of the smile arc and buccal corridors on facial attractiveness as evaluated by orthodontists, general dentists and laymen. Two subjects (one male & one female) were selected from the regional population fulfilling the criteria of an ideal smile arc and ideal buccal corridors. Frontal smile view photographs of these subjects were taken and modified by using adobe photoshop 7.0 to create combination of three smile arc variance and three buccal corridors variations respectively which were shown to 25 orthodontists, 25 general dentists & 25 laymen, to rate the facial attractiveness of each image on a rating scale. All the three groups (laypersons, dentists and orthodontists) showed significant difference in ratings, indicating that they had different perceptions on the facial attractiveness. Orthodontists were more precise in discerning the smile arc and buccal corridors compared to dentists and laypersons.

Variations in the perception of the smile line according to examiners from three different social classes

Objective: This study assessed the variations in the perception of the smile line, according to examiners from three different social classes in the City of Cuiaba, Brazil. Materials and Methods: A total of 12 smile photographs were taken of female students. These photographs were then classified according to the smile line profile presented by each volunteer (ideal, straight and reverse smile line). We selected which side of the smile matched the esthetic norms; later, the smile photographs were digitally duplicated and modified to obtain a symmetrical smile. After the changes were made, each volunteer was classified into the appropriate category. According to this classification, we carried out the alterations in the other two types of smile photos and placed them in an album for subsequent evaluation of the three types of smiles by examiners from three different social classes: A, B and C. Results: There was a lower satisfaction of the subjects with regards to the reverse smile for the examiners from Class A. The lowest satisfaction for the Class B examiners was related to the reverse smile. Data of the comparisons among the Class C examiners revealed no statistical difference between groups ( P > 0.05). Conclusion: There was no statistical difference between the ideal and straight smiles.

The perception of smile attractiveness among Saudi population.

Parameters of dental beauty change across time for varying reasons. Thus, an understanding of the factors that help or harm the attractiveness of a smile is an important step in creating attractive smiles. This study aimed to identify factors that affect smile perception and attractiveness among the Saudi population. A cross-sectional study was conducted among the Saudi population. Questionnaires were distributed to 130 dentists and final-year dental students, and to 130 laypersons. The questionnaire contained six smile photographs created by Photoshop® software. There was a statistically significant difference in scale ratings, based on participant background, for the “gummy” smile picture (P-value =0.003), diastema picture (P-value =0.000) and the “Reverse” smile picture (P-value =0.004). As for sex, males significantly underscored the gummy picture (P-value =0.009). Older people accepted the gummy smile less than did younger people, but diastema was considered as one of the variations that spoiled the attractiveness of the smile. “Dental background” participants significantly identified the ideal smile better than the “nondental” group. The perception of diastema as a sign of beauty among Saudi population in the past has definitely changed, according to the results of our study, where diastema and reverse smile received the lowest score in this survey.

Do dental esthetics have any influence on finding a job?

Our objective was to determine whether dental esthetics have any influence on finding a new job. Ten patients with orthodontic treatment needs for various types of malocclusions were selected. Smiling facial photographs of all patients were obtained and digitally altered (orthodontic correction of teeth). After the images were obtained, 2 different questionnaires were prepared (survey groups A and B) with the photographs without alteration (showing malocclusion) and altered (with orthodontic correction). Subjects appeared in one questionnaire (survey group) with an ideal smile and also in the other (survey group) with a nonideal smile. The images were evaluated by 100 persons responsible for hiring staff for commercial companies. In each survey group, 4 questions were asked regarding the individuals' likelihood of being hired, honesty, intelligence, and efficiency at work. Analysis of variance for repeated measures was used to determine the differences in the evaluations of patients with ideal and nonideal dental esthetics for the 4 characteristics evaluated. The level of significance adopted was 5%. The photographs of persons with ideal dental esthetics were, on average, evaluated as superior with respect to intelligence and likelihood of being hired than were the photographs of the same subjects with nonideal dental esthetics. For the characteristics of honesty and efficiency, no significant differences were observed in the evaluations between those with ideal and nonideal smiles (P<0.05). Persons with ideal smiles are considered more intelligent and have a greater chance of finding a job when compared with persons with nonideal smiles.

Perception of smile esthetics among dental and nondental students

Background: Dental students in their clinical years are part of the dental workforce. The ability of the graduate to identify patient's aesthetic requirements and determine the degree to which those requirements or desires can be met is one of the new dentist's competencies. The perception of dental students toward some esthetic factors of smile was investigated and compared to that of pharmacy students in the same university. Materials and Methods: The authors developed a booklet of smile comprised of an ideal smile and seven altered smiles involving change in shade, shape, width and length of teeth in addition to midline shift and change in the gingival display. Students rated ideal smile and altered smiles using a 100-point visual analog scale (VAS).Results: The study involved 198 students; 108 dental students and 89 pharmacy students and 131 females and 66 males. Mean values for the VAS for the ideal smile were 72, 66 for dental and pharmacy students, respectively. While the mean values for the altered smiles varied between 23 and 65. Ideal smile was rated significantly higher by dental students (P = 0.015) Dental students rated midline shift change in gingival display, alteration in size and shape significantly lower than pharmacy students. While no significant difference was detected between the pharmacy students' ratings of the ideal smile and alterations in shape, size, clinical crown and gingival display.Conclusion: Dental students are more receptive to smile alterations. Dental students appreciated the ideal smile more than pharmacy students. Darker tooth shades, spacing and midline shift were least accepted by both dental and pharmacy students. Dental students were more sensitive to changes in gingival display, crown length, lateral incisors width and shape while pharmacy students were more tolerant to these changes.

The Flexible Party Gums: An Esthetic Alternative for Lost Gingiva

ABSTRACT One of the most important parts of an ideal smile is the presence of healthy gingiva. Healthy gingival tissues affect the esthetics, probably much more than teeth, a factor which is most often neglected in esthetic treatment planning. Periodontal flap surgeries often leave open embrasure spaces which are a huge esthetic deficit for the patient. Replacing the missing gingival tissue with composite, ceramic, acrylic or silicone has been reported in the literature. This case report describes the use of a gingival prosthesis fabricated by valplast-a flexible nylon- based material to recreate the lost soft tissue esthetics. How to cite this article Agrawal TR, Dange S, Khalikar S. The Flexible Party Gums: An Esthetic Alternative for Lost Gingiva. Int J Prosthodont Restor Dent 2014;4(1):20-22.

Perceptions of dental professionals and laypeople to altered dental esthetics in cases with congenitally missing maxillary lateral incisors

BackgroundThe smile perception of patients is not strictly related to standardized protocols and technical implications which certainly affect clinicians' decisions. The absence of maxillary lateral incisors could affect smile esthetics either with treatment or not. The aim of the present study was to investigate if different perceptions on altered smiles due to missing maxillary lateral incisors, with or without treatment, exist among different groups of people (laypersons, adult orthodontic patients, general dentists, and orthodontists).MethodsAn ideal smile model was selected and altered simulating different malocclusions and treatment options. Twelve simulations were submitted to four categories of respondents: laypeople, adult orthodontic patients, general dentists and orthodontists. They were asked to express smile perception for each simulation by ranking and rating simulations using a 0 to 100 visual analog scale. Analysis of variance was used to determine if there were statistically significant differences in values assigned among the four categories of respondents for each simulation.ResultsSignificant differences in smile perceptions were found between professionals (dentists and orthodontists) and laypeople. Presence of dental tipping and marked diastema in the arch were disharmonious aspects less tolerated in a smile by all categories of evaluators. Simulations associated with space closure orthodontic treatment were ranked as the most attractive smile and significantly ranked higher by dental professionals than patients and laypeople.ConclusionsTreatment, absence of diastema, and symmetry were the most accepted characteristics by all categories of respondents. Ideal orthodontic treatment options might be overestimated by clinicians when compared to laypeople's smile perception.

Influence of malocclusion on social perceptions of adolescents at public and private schools

To determine whether malocclusion influences adolescents' perception when judging their colleagues from the aspects of athletics, social and health status, leadership and academic skills. Front view photographs of the smile of eight adolescent volunteers (non-ideal smile) were altered to create an image with aligned teeth (ideal smile). Two parallel groups were programmed with the subjects' photographs. When the image of an ideal smile of one of the subjects appeared in one of the groups, the image of the non-ideal appeared in the other. Two hundred adolescents were evaluators, half of the students being from private and half from public schools. They classified the group images indicating their social perception with respect to skills in sports, leadership, academic activities, popularity and the health conditions of each subject. The majority of photographs of subjects with an ideal smile were evaluated as being better when compared with photographs of the non-ideal smile. The differences in the evaluations between the ideal and non-ideal smiles were significant for the perception of popularity, intelligence, leadership capability and health, differently from the performance in sports, as this aspect did not attain statistical relevance. Malocclusion has influence on the perception of adolescents of different social levels when judging youngsters with or without malocclusion from the aspects of athletics, social and health status, leadership and academic skills.

Factors Affecting Smile Esthetics

ABSTRACT Smiling has been one of the areas that draw the interest of orthodontists due to esthetic concerns in recent years. It should be understood what an ideal smile is and which factors affect it, and these should certainly be reflected in the orthodontic treatment plan. The purpose of this review is to describe smiling and to examine factors affecting smile and smile evaluation methods.

Dental Smile Esthetics: The Assessment and Creation of the Ideal Smile

Esthetic considerations continue to become more relevant in dental treatment planning. Patients are becoming increasingly conscious of the significance of a beautiful smile in relation to facial beauty. Traditionally, dentists have focused on restoring health and functional elements of the dentition. Contemporary smile design is a relatively new concept, and techniques and philosophies are constantly evolving. This article describes the factors that need to be considered in the assessment and creation of the ideal smile, with emphasis on the integration of all the essential components of a smile: facial, gingival, and dental esthetics of the teeth. Esthetic considerations continue to become more relevant in dental treatment planning. Patients are becoming increasingly conscious of the significance of a beautiful smile in relation to facial beauty. Traditionally, dentists have focused on restoring health and functional elements of the dentition. Contemporary smile design is a relatively new concept, and techniques and philosophies are constantly evolving. This article describes the factors that need to be considered in the assessment and creation of the ideal smile, with emphasis on the integration of all the essential components of a smile: facial, gingival, and dental esthetics of the teeth.

Esthetic orthodontic treatment with a double J retractor and temporary anchorage devices

This clinical article reports an esthetic treatment option for managing a Class II malocclusion in an adult. The patient, a woman aged 24 years 2 months, had crowding and a convex profile. She was treated with maxillary first premolar extractions, a double J retractor, and temporary skeletal anchorage devices in the maxillary arch. Posttreatment records after 2 years showed excellent results with good occlusion and long-term stability.

Influence of dental esthetics on social perceptions of adolescents judged by peers

The relationship between physical appearance and social attractiveness is well established in the literature. The purpose of this study was to determine whether dental esthetics influenced the perceptions of teens when judging a peer's athletic, social, leadership, and academic abilities. The frontal-face smiling photographs of 10 teenage volunteers were each altered to create 1 image with an ideal arrangement of teeth and 1 with a nonideal arrangement. Two parallel surveys were constructed with 1 photo displaying either an ideal or a nonideal smile image of each subject. If the ideal smile image appeared in 1 survey, then the nonideal smile appeared in the other. Two hundred twenty-one peer evaluators successfully rated the pictures in 1 of the surveys by indicating their perception of each subject's athletic, social, leadership, and academic abilities. The subjects' photographs with ideal smile esthetics were consistently rated higher on average than the same subjects' images with nonideal smile esthetics. The differences in ratings between ideal and nonideal smiles were significant for perceptions of athletic performance (P = 0.0141), popularity (P <0.0001), and leadership ability (P <0.0001), but not for academic performance (P = 0.0548). On average, ratings for the ideal smiles in perceived athletic, social, and leadership skills were about 10% higher than those given for images with nonideal smiles. Based on these findings, it would be expected that orthodontic treatment resulting in improved smile esthetics can provide modest social benefits for adolescent patients.

Transposition of a maxillary canine and a lateral incisor and use of cone-beam computed tomography for treatment planning

This report describes the orthodontic treatment of a 12-year-old girl with transposition of the maxillary left canine and the lateral incisor. Cone-beam computed tomography was used during treatment planning. The transposed tooth positions were corrected with an unconventional orthodontic approach. Treatment alternatives and their clinical concerns are presented.

Functional and Esthetic Rehabilitation with In-Ceram Alumina and Zirconia System: A Multidisciplinary Approach

The development of all-ceramic systems following metalceramics restorations allowed simulation of natural dentition due to favorable esthetics and resistance. In-Ceram is an alternative when esthetics is primordial as well as resistance required in rehabilitation. However, an ideal smile is associated to not only shape, color, texture and translucency but also harmony with gingival tissue. So, the aim of this study is to report a clinical case based on periodontal and fixed partial dentures principles to perform periodontal plastic surgery followed by esthetic rehabilitation. A female patient, 40-year-old, presented complaint about dental esthetics. After clinical and radiographic exams, metal-ceramics crowns (teeth 11, 12, 13, 21, 22 and 23) were considered unsatisfactory due to marginal leakage, color change in gingival tissue associated to metallic margin, and gummy smile. So, a crown lengthening surgery of anterior teeth was performed followed by rehabilitation of superior teeth with In- Ceram single crowns. The interaction between periodontics and fixed prosthodontic area is the key of an adequated treatment planning which involves gingival smile to provide function and an esthetic condition in association with an esthetic, resistant and predictable material.

Smile esthetics from the layperson’s perspective

Computer-based smile esthetic surveys based on slider technology allow more precise control of variables and the possibility of obtaining continuous data. Variations in the perception of smiles from different facial perspectives have not been resolved. The objective of this study was to quantify the ideal and the range of acceptable values for smile variables judged by laypersons from a full-face perspective for comparison with lower-face data. Mirrored and symmetric male and female full faces previously determined by peers to be of average attractiveness were used. Ninety-six laypersons judged these smile variables: smile arc, buccal corridor fill, maxillary gingival display, maxillary midline to face, maxillary to mandibular midline discrepancy, overbite, central incisor gingival margin discrepancy, maxillary anterior gingival height discrepancy, incisal edge discrepancy, and cant. The judges manipulated the variables using adjustable image technology that allowed the variable to morph and appear continuous on a computer monitor. Medians for each smile variable were compiled, and the Fleiss-Cohen weighted kappa statistic was calculated to measure reliability. Multiple randomization tests with adjusted P values were used to compare these data with those for lower-face views. Reliability ranged from 0.25 for ideal overbite to 0.60 for upper midline to face, except for upper and lower buccal corridor limits, which each had a kappa value near 0. There were no statistically significant differences between the ratings of male and female raters. The following variables showed statistically and clinically significant differences (>1 mm) when compared with the lower-face view: ideal smile arc, ideal buccal corridor, maximum gingival display, upper to lower midline, and occlusal cant. Although the smile arc values differed because of model lip curvature variations, the principle of tracking the curve of the lower lip was confirmed. For the full-face view, the raters preferred less maximum gingival display, less buccal corridor, more upper to lower midline discrepancy, and less cant of the occlusal plane. Reliability was fair to moderate with the exception of the buccal corridor limits. Most variables showed no clinically meaningful differences from the lower-face view. The acceptable range was quite large for most variables. Detailed knowledge of the ideal values of the various variables is important and can be incorporated into orthodontic treatment to produce an optimal esthetic smile.

Gummy Smiles: The Challenge of Gingival Excess: Prevalence and Guidelines for Clinical Management

Orthodontic treatment planning should be a multidisciplinary approach to achieve periodontal health and maximal esthetics. The presence of altered passive eruption may complicate treatment in the presence of inflammation and compromise esthetic outcomes. The prevalence, diagnosis, and treatment of active and arrested passive eruption in the orthodontic patient will be the focus of this article. In a recent landmark study, the prevalence of altered passive eruption in postorthodontic patients, and the same patients 5 years after treatment, were studied for their need for periodontal plastic surgery, esthetic crown lengthening. Less than ideal smile characteristics, namely length-to-width ratios and asymmetry, were found in 65% and 60% of patients, respectively. Enhancing orthodontic results and providing the patient with maximal esthetic results can be achieved through the control of inflammation and esthetic crown lengthening.

Planeamento Estético na Restauração Directa de Dentes Anteriores: Técnica de Simulação Semi-Directa

In the last years, beauty and harmony stereotypes have dominated human relationships, being the word aesthetics used in several areas of our society. The definition of an ideal smile is based not only on objective measurable criteria but also includes subjective parameters. The pre-visualization of the final result of a planned anterior rehabilitation gives the opportunity for the professional and the patient to evaluate if the changes to be performed correspond to their aesthetics and functionality expectations. ObjectiveTo describe a semi-direct simulation technique of anterior teeth restorations, based on clinical cases, and enumerate its advantages and limitations. MethodIn the first appointment photographs are taken and preliminary impressions are made. The casts are articulated in centric relation. The moch-up is made with a composite resin. The cast modifications are printed using a high viscosity polivinilsiloxane to create a restoration key. On a second appointment a self-cure acrylic resin is added to the key and than is introduced in the patient's mouth in order to pre-visualize the possible final result. These provisory restorations can be cemented so that the patient can adapt herself to the new look. The silicon key can also work as guide for the definitive restoration. ConclusionThis technique proved to be of easy execution, quick and efficient, although it can’t be used in situations of vestibular position or extruded teeth. It has the advantages of being an additive and reversible technique, and the silicon key facilitates the definitive restoration execution.

Esthetics and Smile Characteristics From the Layperson's Perspective: A Computer-Based Survey Study

The paradigm shift from occlusion to esthetics places more emphasis on the subtle relationships among the teeth and the interplay with the soft tissues. The authors of this study quantified the ideal and maximum acceptable deviations for smile characteristics. The authors created a survey by using a digital image editing software package, which enabled raters to manipulate intraoral photographs featured in the survey. They altered smile characteristics in photos of a sex-neutral face showing nasal tip to mentolabial fold. The authors administered an electronic survey in Boston (n = 78); Columbus, Ohio (n = 81); and Seattle (n = 84). An interactive interface allowed raters to select the ideal for each smile characteristic presented and identify the range of acceptability for the variables. Raters were reliable (kappa = 0.34-0.88). Survey location was not significant except that raters from the West accepted a broader smile than did those from the Midwest and the East. Raters identified ideals and thresholds for the following smile characteristics: smile arc; buccal corridor; gingival display; canine and posterior crown torque, ideal and large corridor; maxillary midline to face; maxillary to mandibular midline; overbite; maxillary central incisor gingival height discrepancy; maxillary lateral incisor gingival height discrepancy; maxillary central to lateral incisal step; maxillary central incisor crown width-to-height ratio; maxillary central-to-lateral incisal ratio; and occlusal cant. Generally, the values for ideal paralleled existing data, and new guidelines for some variables emerged. The ranges of acceptability were large. The ideal and an acceptable range for each smile characteristic can be identified reliably. Laypeople can reliably identify ideal smile characteristics. The ranges of acceptable deviations for smile characteristics are large, and practitioners should avoid unnecessarily sensitizing patients to minor discrepancies.